Primary pediatric brain tumors in Africa: a systematic review and comparative meta-analysis.
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OBJECTIVE: Pediatric brain tumors (PBTs), a significant cause of childhood mortality, remain underexplored in Africa. The authors analyzed the existing African literature on PBTs to determine their prevalence, assess treatment effectiveness, and report overall outcomes. METHODS: A systematic review of the literature using the PubMed, Google Scholar, Embase, and Web of Science databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review included meta-analysis using random-effects modeling to quantitatively summarize patient demographic characteristics, diagnostics, treatments, and outcomes, in addition to qualitative descriptions of challenges and solutions in managing PBTs in Africa. RESULTS: The authors included 5256 pediatric patients from 35 retrospective/prospective studies across 10 African countries in their analysis. Among 28 articles reporting sex, 56.3% (2431/4312) of patients were male. Regarding tumor grading, World Health Organization (WHO) low-grade tumors prevailed at 63.5% of cases (714/1125) in 16 studies. According to the included studies, the most commonly reported tumor types included astrocytoma (18.6%, 95% CI 11.2%-29.3%), medulloblastoma (15.6%, 95% CI 8.8%-26.0%), craniopharyngioma (13.4%, 95% CI 6.1%-27.0%), and ependymoma (7.0%, 95% CI 4.8%-10.1%). In 11 studies, 55.4% of tumors were supratentorial (739/1335) and 43.7% (584/1335) were infratentorial. Of the 13 articles detailing management, surgical management was adopted in 86.1% (95% CI 66.7%-95.0%) of cases. At a mean follow-up period of 32.2 months (95% CI 10.5-53.8), the mortality rate at last follow-up was 30.3% (341/1126). Across the included studies, North Africa had a higher reported rate of surgical intervention at 97.4% (95% CI 39.4%-100.0%) compared to sub-Saharan Africa at 77% (95% CI 59.4%-88.5%), with a corresponding lower mortality rate of 18.8% (95% CI 7.0%-41.4%) compared to 36.7% (95% CI 19.2%-58.5%) in sub-Saharan Africa. These figures represent estimates based on the reported values in the published literature. Challenges and proposed solutions were reported in 13 studies: 6 indicated the need for a childhood cancer registry, whereas 7 identified obstacles in healthcare resources and infrastructure while advocating for comprehensive strategies to enhance multidisciplinary care and modernize facilities. CONCLUSIONS: The authors' study sheds light on the prevalence of PBTs in Africa and highlights significant gaps in diagnosis, management, and outcomes. Disparities between sub-Saharan Africa and North Africa in cancer burden, diagnostic methods, treatment management, and survival outcomes suggest the need for targeted interventions. The reported mortality rates emphasize the urgency of improving brain tumor management and postoperative care for pediatric patients in Africa.