SynthesisBMC pediatrics2026
Nutritional status and associated factors in Ethiopian children with congenital heart disease: a systematic review and meta - analysis.
Synthesis in BMC pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn low-resource settings like Ethiopia, Congenital Heart Disease is frequently complicated by a high yet poorly defined burden of malnutrition. To address this gap, this systematic review and meta-analysis aimed to rigorously quantify the pooled prevalence of undernutrition and identify determinants driving this condition among affected Ethiopian children.
methodsAdhering to PRISMA guidelines and a prospective registration, this systematic review and meta-analysis included non-randomized studies reporting on malnutrition in Ethiopian children with congenital heart disease, which were identified through a comprehensive search of PubMed, Medline, HINARI, ScienceDirect, Scopus and Google Scholar up to November 15, 2025. The risk of bias was appraised using the Newcastle-Ottawa Scale, and data synthesis was performed in Stata version 17 using a random-effects meta-analysis to calculate pooled prevalence and Odds Ratios with 95% Confidence Intervals. Heterogeneity was quantified using the I2 statistic, while the robustness of the findings was evaluated through subgroup and leave-one-out sensitivity analyses. To address publication bias identified via funnel plot asymmetry, a non-parametric trim-and-fill analysis was applied to generate a more robust adjusted pooled prevalence, with forest plots utilized to visualize all individual and aggregate results.
resultsA total of 1,849 children across seven studies were included in the analysis. The overall pooled prevalence of undernutrition among Ethiopian children with CHD was estimated at 44.48% (95% CI: 38.44% − 50.52%, I2 = 95.3%). Significant associated factors for undernutrition were the presence of heart failure (OR = 4.12, 95% CI: 3.74–4.50, I2 = 4.2%), pulmonary hypertension (OR = 2.53, 95% CI: 1.93–3.13, I2 = 89.1%) & comorbidities (OR = 1.39, 95% CI: 1.25–1.54, I2 = 93%).
conclusionUndernutrition impacts approximately 45% of Ethiopian children with congenital heart disease, primarily driven by clinical challenges like heart failure and pulmonary hypertension, which necessitates a shift toward integrated, multidisciplinary pediatric care. However, the reliability of this prevalence rate is undermined by significant statistical heterogeneity and the non-randomized nature of existing research, creating a high risk of bias and limited generalizability. To address these critical limitations, it is recommended that both clinical and research frameworks adopt standardized malnutrition diagnostic criteria and more rigorous study designs to ensure that future interventions are based on consistent, high-quality data rather than fragmented estimates.
trial registrationCRD420251230006.
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