Background & Objective: Anaesthesia-related mortality in developing countries has previously been estimated based on data from studies that are indexed in medical databases such as PubMed.1 We set out to estimate anaesthesia-related mortality in Sub-Saharan African countries based on systematically searched studies from both medical databases and the grey literature. 

Methods: A systematic research of studies from Sub-Saharan African countries (with the exception of South Africa), reporting on dichotomous anaesthesia-related mortality data (i.e. the number of deaths with a denominator) was done in medical databases (PubMed, Cochrane, Web of Science, Embase) to April 2017. We also searched the grey literature including Google, African medical journals that are not indexed in medical databases, reports from African National Congresses on obstetrics or surgery, and medical theses. Anaesthesia-related mortality was defined as reported in the individual reports. No restriction on publication date, language, or type of surgery was applied. 

Results: From 2112 retrieved reports, 170 (1,054,364 patients) were included: 103 reports (median size, 882,734 patients; range 7 to 91,032) were from medical databases and 67 reports (average size, 171,630 patients; range 16 to 45,974) from the grey literature. In studies retrieved from medical databases, average mortality rate was 5.4/10,000, in the grey literature it was 21.3/10.000 (weighted mean of overall anaesthesia-related mortality, 8/10,000). 

Conclusion: Anaesthesia-related mortality in Sub-Saharan African countries is high. Mortality rates as reported in the literature indexed in medical databases is only about one fourth of the mortality rates derived from the grey literature. Is likely that previously published estimates largely underestimated the true burden of anaesthesia-related mortality in Sub-Saharan African countries.(1) 

References
(1)	Bainbridge D, Martin J, Arango M, Cheng D. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. Lancet 2012;380:1075–81

03 / Anaesthesia-related mortality in Sub-Saharan African countries. A quantitative systematic review.