Obstructive Jaundice in Sub-Saharan Africa: A Narrative Review of Diagnostic and Therapeutic Pathways, Contextual Challenges, and a Proposed Resource-Stratified Framework
Year: 2026
Type: review
Abstract: Obstructive jaundice in sub-Saharan Africa (SSA) is managed in conditions that differ sharply from high-income practice. Regional case series report malignant causes, chiefly pancreatic head tumours and cholangiocarcinoma, as the leading aetiology, and endoscopic retrograde cholangiopancreatography (ERCP) remains scarce across most of the region. This narrative review synthesises the regional evidence, the contextual challenges that shape how it can be applied and the unresolved clinical practice gaps, and proposes a resource-stratified management framework. MEDLINE, African Journals Online, African Index Medicus and Google Scholar were searched from January 2000 to June 2026, giving priority to studies from, or directly addressing, SSA settings. The evidence is geographically incomplete and comes mainly from English-language, single-centre series in Uganda, Tanzania, Malawi, Ghana and Rwanda. Three observations emerge. First, reported aetiology and treatment may reflect locally available capacity as well as disease biology: the one Rwandan series with local ERCP and percutaneous drainage was stone-dominant and mostly treated without surgery, while series from centres without that capacity were malignancy-dominant and surgery-dominant. This is a hypothesis resting on one contrasting series, and differences in referral populations and case ascertainment may explain part of it. Second, delay accumulates along the care pathway, so low resectability at presentation partly reflects elapsed time. Third, outcome definitions differ between series, which prevents comparison. Three practice gaps follow: preoperative drainage guidance that assumes rapid access to surgery, little documented multidisciplinary input, and non-standardised outcome reporting. A six-part conceptual framework and a capacity-stratified algorithm are proposed, built from the authors' synthesis of this literature and clinical experience. Neither has been validated or piloted. Both need local adaptation, consensus testing and prospective evaluation before use as a clinical or reporting standard.
DOI: 10.2147/hmer.s649519
Institutions: Kabale University, Kabale Hospital
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,320
OpenAlex ID: W7225156613