Epidemiology, management and outcome of acute respiratory distress syndrome in Sub-Saharan Africa: a systematic review

Objectives To evaluate the incidence, management, and outcomes of Acute Respiratory Distress Syndrome (ARDS) in Sub-Saharan Africa (SSA), and to identify challenges related to healthcare infrastructure and resource availability. Design Systematic review of published studies on ARDS in SSA. Setting Studies conducted across hospitals and intensive care units in 11 countries within Sub-Saharan Africa between 2000 and 2024. Participants Adult patients diagnosed with ARDS. Main outcome measures Prevalence of ARDS, patient demographics, management strategies, availability of critical care resources, and mortality rates. Results Thirteen studies met the inclusion criteria. ARDS prevalence varied widely, ranging from 2.4% to 100%. The Kigali modification of the Berlin criteria was most frequently applied, reflecting limited access to chest radiography and arterial blood gas analysis. Pneumonia, sepsis, and trauma were the predominant causes, with infectious diseases such as HIV, tuberculosis, and malaria contributing substantially. Access to invasive mechanical ventilation and other critical care resources was limited. Reported mortality rates ranged from 22% to 77%. Conclusions ARDS represents a major but under-recognised cause of morbidity and mortality in SSA. Resource limitations, including inadequate diagnostic capacity and restricted access to mechanical ventilation, likely contribute to poor outcomes. Efforts to strengthen critical care infrastructure, provide targeted training, and adapt diagnostic criteria for low-resource environments are urgently needed. Further research should explore regional variations and context-appropriate interventions to improve ARDS care across SSA.