Effect of off-hours admission on in-hospital mortality in sub-Saharan Africa: a systematic review and meta-analysis

BACKGROUND: The findings of previous works of literature on the effects of off-hours admission on in-hospital mortality in sub-Saharan Africa were inconsistent and inconclusive. However, there is paucity of information as single summarized finding. Therefore, this review aimed to determine the pooled effects of off-hours admission on the in-hospital mortality in sub-Saharan Africa. METHODS: A systematic review and meta-analysis were conducted using studies from PubMed, MEDLINE, Cochrane Library, Web of Science, African Journals Online, and Google Scholar up to 30/12/2025. Study quality, heterogeneity and publication bias were assessed accordingly. Pooled estimates were estimated using a random-effects model. Subgroup and sensitivity analyses were performed. Odds ratios with 95% confidence intervals were used to quantify the association between off-hours admission and in-hospital mortality. RESULTS: This review included 14 primary studies. The pooled magnitude of off-hours in-hospital mortality among all hospital admissions in sub-Saharan Africa was 12.39% (95% CI: 9.76, 15.02%). The nighttime mortality among the nighttime admissions was 26.1% (95%CI: 18.6, 33.6%). Besides, the pooled weekend's in-hospital mortality among weekends' admissions in sub-Saharan Africa was 31.5% (95% CI: 23.5, 39.5%). The pooled effects of off-hours admission on in-hospital mortality was higher for weekend admission (OR = 1.22, 95% CI: 1.01, 1.47) and nighttime admission (OR = 2.36, 95% CI: 1.40, 4.00) compared with weekday admission. CONCLUSIONS: Off-hours admission may be associated with increased mortality; however, the findings should be interpreted cautiously due to substantial heterogeneity and variability in study definitions. REGISTRATION: The protocol was registered at PROSPERO with reg. no "CRD42024621339".