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Volume 22
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10.3390/ijerph22101504
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Systematic Review

Clinical Outcomes of Severe Lassa Fever in West Africa: A Systematic Review and Meta-Analysis

by
Azuka Patrick Okwuraiwe
1,
Chizaram Anselm Onyeaghala
2,*,
Obiageli Theresa Ozoude
3,
Muritala Odidi Suleiman
4,
Samirah Nndwan Abdu-Aguye
5,
Nkolika Jacinta Ezekwelu
6,
Tolulope Amos Oyeniyi
7,
Ayodapo Oluwadare Jegede
8,
Adaeze Elfrida Egwudo
6,
Oluchukwu Perpetual Okeke
9,
Olunike Rebecca Abodunrin
10,
Folahanmi Tomiwa Akinsolu
9,11 and
Olajide Odunayo Sobande
9
1
Centre for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Lagos 101212, Nigeria
2
Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt 500001, Nigeria
3
Department of Microbiology, Veritas University, Bwari Area Council, Abuja 900106, Nigeria
4
Department of Human Anatomy, Federal University, Dutse 720101, Nigeria
5
Department of Clinical Pharmacy and Pharmacy Practice, Ahmadu Bello University, Zaria 800001, Nigeria
6
Department of Community Health and Primary Care, Lagos University Teaching Hospital, Lagos 100254, Nigeria
7
Department of Public Health and Epidemiology, Nigerian Institute of Medical Research, Lagos 101245, Nigeria
8
Department of Clinical Pharmacy and Pharmacy Administration, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
9
Nigerian Institute of Medical Research Foundation, Lagos 1000001, Nigeria
10
Department of Epidemiology and Biostatistics, Nanjing Medical University, Nanjing 210029, China
11
Clinical Sciences Department, Lead City University, Ibadan 200255, Nigeria
 
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Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2025, 22(10), 1504; https://doi.org/10.3390/ijerph22101504
Submission received: 6 July 2025 / Revised: 27 August 2025 / Accepted: 16 September 2025 / Published: 30 September 2025
Versions Notes

Abstract

Lassa fever (LF) is an acute viral hemorrhagic fever that poses a substantial public health security threat in West Africa. The non-specific clinical presentation of LF, coupled with a lack of reliable point-of-care diagnostics, means delayed diagnosis, leading to severe complications and mortality during epidemics. A systematic review and meta-analyses were performed by conducting an extensive online search using PubMed, Web of Science, Scopus, CINAHL, and Google Scholar (PROSPERO protocol identifier number CRD42024587426). Only peer-reviewed studies written in English were included in publications from September 1, 2014, to August 31, 2024. The analysis and reporting followed PRISMA guidelines. The quality of the included studies was assessed using the critical appraisal tools developed from the Joanna Briggs Institute Systematic Review Checklist for cohort studies. We included 19 studies that contained data from 4177 patients hospitalized with LF of any age. Most included studies employed a retrospective cohort design and were conducted in Nigeria (16/19; 84.2%). The mortality rate was highest in a Sierra Leonean study (63.0%), whereas a group-based analysis of Nigerian studies using a random-effects model identified Owo as having the highest mortality rate of 13% (95% CI: 6–23; I2 = 98%). The pooled mortality rate for severe LF was 19% (95% confidence interval [CI]:10–32). The most common complications of LF are acute kidney injury (AKI) at a pooled proportion of 19% (95% CI; 13–26; I2 = 89%)), followed by abnormal bleeding at a pooled proportion of 17% (95% CI; 9–30; I2 = 98%), and central nervous system (CNS) dysfunction at a pooled proportion of 15% (95% CI; 6–32; I2 = 98%).
Keywords: Lassa fever; West Africa; mortality rate; abnormal bleeding; acute kidney injury; CNS dysfunction Lassa fever; West Africa; mortality rate; abnormal bleeding; acute kidney injury; CNS dysfunction

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MDPI and ACS Style

Okwuraiwe, A.P.; Onyeaghala, C.A.; Ozoude, O.T.; Suleiman, M.O.; Abdu-Aguye, S.N.; Ezekwelu, N.J.; Oyeniyi, T.A.; Jegede, A.O.; Egwudo, A.E.; Okeke, O.P.; et al. Clinical Outcomes of Severe Lassa Fever in West Africa: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2025, 22, 1504. https://doi.org/10.3390/ijerph22101504

AMA Style

Okwuraiwe AP, Onyeaghala CA, Ozoude OT, Suleiman MO, Abdu-Aguye SN, Ezekwelu NJ, Oyeniyi TA, Jegede AO, Egwudo AE, Okeke OP, et al. Clinical Outcomes of Severe Lassa Fever in West Africa: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2025; 22(10):1504. https://doi.org/10.3390/ijerph22101504

Chicago/Turabian Style

Okwuraiwe, Azuka Patrick, Chizaram Anselm Onyeaghala, Obiageli Theresa Ozoude, Muritala Odidi Suleiman, Samirah Nndwan Abdu-Aguye, Nkolika Jacinta Ezekwelu, Tolulope Amos Oyeniyi, Ayodapo Oluwadare Jegede, Adaeze Elfrida Egwudo, Oluchukwu Perpetual Okeke, and et al. 2025. "Clinical Outcomes of Severe Lassa Fever in West Africa: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 22, no. 10: 1504. https://doi.org/10.3390/ijerph22101504

APA Style

Okwuraiwe, A. P., Onyeaghala, C. A., Ozoude, O. T., Suleiman, M. O., Abdu-Aguye, S. N., Ezekwelu, N. J., Oyeniyi, T. A., Jegede, A. O., Egwudo, A. E., Okeke, O. P., Abodunrin, O. R., Akinsolu, F. T., & Sobande, O. O. (2025). Clinical Outcomes of Severe Lassa Fever in West Africa: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 22(10), 1504. https://doi.org/10.3390/ijerph22101504

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