Prevalence of Meningitis and Pneumonia among Neonates Treated at Public Hospitals in Ethiopia: A Systematic Review and Meta-Analysis

Background: Neonatal meningitis and pneumonia are important causes of morbidity and mortality among hospitalized newborns in low-resource settings. Numerous single-centre studies have been conducted in Ethiopian public hospitals, yet no quantitative synthesis of neonatal meningitis prevalence previously existed, and the depth of the pneumonia-specific evidence base was undocumented. This review aimed to estimate the pooled prevalence of neonatal meningitis, and to establish the state of the evidence base for neonatal pneumonia, among neonates treated at public hospitals in Ethiopia. Methods: A systematic search of PubMed/MEDLINE, PubMed Central, PLOS, BioMed Central, Frontiers, Taylor & Francis Online, and institutional repositories was conducted without date restriction. Cross-sectional and retrospective studies reporting a standalone prevalence of neonatal meningitis or neonatal pneumonia among neonates treated at Ethiopian public hospitals were eligible. Methodological quality was appraised using the JBI Critical Appraisal Checklist for prevalence studies. A random-effects meta-analysis pooled meningitis prevalence; heterogeneity was quantified with I2 and Cochran's Q. Results: Of 26 full-text articles assessed for eligibility, four studies (N = 3,522 neonates) met inclusion criteria for neonatal meningitis; none met inclusion criteria for a standalone neonatal pneumonia prevalence outcome. The pooled prevalence of neonatal meningitis was 6.26% (95% CI: 2.81-13.35%; I2 = 96.6%), with individual study estimates ranging from 1.73% to 19.30%. A sensitivity analysis restricted to the three studies using a "suspected-meningitis" denominator yielded a pooled prevalence of 4.23% (95% CI: 1.92-9.05%). No eligible primary study reported neonatal pneumonia prevalence as a standalone, separately ascertained outcome across the accessible literature, pneumonia is consistently subsumed within composite "neonatal sepsis" case definitions. Conclusion: An estimated 1 in 16 to 1 in 24 neonates tested for suspected meningitis at Ethiopian public hospitals had a culture-confirmed or clinically diagnosed case, with wide variation across settings and case-ascertainment methods. A previously undocumented evidence gap exists for standalone neonatal pneumonia prevalence in Ethiopia. Future primary studies should report pneumonia as a distinct, separately ascertained neonatal outcome to enable future quantitative synthesis.