Current trends in burden and management of pediatric osteomyelitis in the African continent: a systematic review of the last decade.

Abstract

<h4>Introduction</h4>In low-income countries faced by a constraint of resources, pediatric osteomyelitis is a major cause for morbidity, and its true burden in Africa has not been fully characterized.<h4>Objectives</h4>To systematically synthesize evidence on the clinical presentation, microbiology, management strategies, outcomes, and novel insights in pediatric osteomyelitis in the last decade within Africa.<h4>Methods</h4>The review was conducted using Pubmed, Scopus, Embase and Google Scholar to identify studies addressing pediatric osteomyelitis in Africa. Relevant literature covering osteomyelitis types, diagnostic criteria, pathogen and resistance data, treatment modalities, outcomes, length of stay, and follow-up duration were included. Nine studies were identified and analyzed.<h4>Results</h4>Among the identified cases (<i>n</i> = 284), 83.5% were chronic. The tibia (45.7%) and femur (31.7%) were the most commonly affected sites. Bacterial cultures were available for 130 cases and showed <i>Staphylococcus aureus</i> as the leading pathogen (43.9%). Exclusive surgical care was indicated in 51.85% of the cases, and the procedures included sequestrectomy and reconstructive procedures. Notable novel patterns included higher rates of chronic multifocal disease in rural, malnourished children; variable empiric antibiotic regimens driving antimicrobial resistance; and the use of gentamicin loaded beads and vascularized fibula flaps for post-osteomyelitis reconstruction.<h4>Conclusion</h4>Chronic osteomyelitis is the most dominant form in African children. Despite advancements in management in African settings, gaps exist. Future directions include multicenter surveillance of disease burden, surveillance of antimicrobial resistance, community-level interventions for disease monitoring and capacity building for advanced surgical procedures.