Bariatric Procedures in the Sub-Saharan Africa: A Systematic Review of Patterns and Outcomes.

BACKGROUND

Sub-Saharan Africa faces rising obesity rates with limited access to bariatric care due to a scarcity of facilities and trained personnel. This systematic review aimed to analyse the types of bariatric procedures available in sub-Saharan Africa and their outcomes. The results of this study may promote the establishment of a continental registry to improve metabolic care outcomes.

METHODS

A literature search was conducted using the Cochrane Library, PubMed, and EBSCOHost. Studies conducted in North Africa were excluded. Quality appraisal was performed using the ROBINS-I tool. We could not perform a meta-analysis because of the heterogeneous data from the different procedures used to treat obesity in sub-Saharan Africa. This study was registered in the PROSPERO registry.

RESULTS

Only nine studies (2016-2024) involving 974 patients were included. Most procedures were concentrated in Southern Africa, with no data from East African countries. The patients were predominantly female (80.8%). Gastric banding and intragastric balloon were the most common procedures in Southern Africa and West Africa, respectively. Outcomes were discussed in only seven studies, which included 626 patients. The most prevalent complication was calcium deficiency (8.4%) which was mainly observed in gastric bypass surgeries.

CONCLUSIONS

Due to the absence of studies from the East African sub-region, this review highlights the geographic disparity in the availability of bariatric procedures in sub-Saharan Africa. There was variation in the types of bariatric procedures performed by the surgeons in the subregions. Gastric banding is associated with lower estimated weight loss than other bariatric procedures in sub-Saharan Africa. Nutrient deficiencies were more common in gastric bypass procedures.