Deep vein thrombosis in Ethiopia: a systematic review and meta-analysis, 2025

Abstract

Introduction

See More

Deep Vein Thrombosis is a significant public health concern associated with high morbidity and mortality, mainly when left undiagnosed or untreated. In Ethiopia, fragmented data from various studies have reported varying prevalence and risk factors, necessitating a comprehensive synthesis. This systematic review aimed to identify and summarize the key factors contributing to deep vein thrombosis among patients in Ethiopia.

Methods

The study used a systematic review and meta-analysis design, sourcing evidence from various electronic databases until April 04, 2025. Data was extracted from March 10–15 and analyzed from March 15–25, with the report generation until April 04, 2025. The mortality rate was assessed using the pooled odds ratio and the pooled proportion. A meta-analysis was conducted using R software, with forest plots for visual representation. Heterogeneity was evaluated using the I² statistic. The quality of the studies was assessed using validated tools.

Results

The review showed the pooled prevalence of deep vein thrombosis from eight articles was 5.6%( CI: 2.9, 8.5), with a 5% mortality rate (CI: 3, 8), and a 7.15%( CI: 2, 12) recurrence rate. Advanced age, being male, pregnancy, hypertension, diabetes, comorbid conditions, and a history of Deep Vein Thrombosis, high cholesterol level, orthopedic trauma, Alcohol consumption, and obesity, Patients with bilateral Deep Vein Thrombosis prolonged hospitalization, ward admission, and patient transfer from other hospitals, and use of central venous catheters were associate with increased the risk of Deep Vein Thrombosis development.

Conclusion and recommendation

: The review showed that Deep Vein Thrombosis is a significant health concern in Ethiopia, with a prevalence of 5.6%, a mortality rate of 5%, and a recurrence rate of 7.15%. Factors such as advanced age, pregnancy, prior deep-vein thrombosis, comorbidities, intensive care unit admission, surgery, prolonged hospitalization, and central venous catheter use increase risk. To reduce DVT-related complications, routine risk assessments, early intervention strategies, and strengthened hospital protocols are essential.

Registration number

: CRD420251024491 was registered with PROSPERO on 06 April 2025.

Highlight

What is Known.

• Varying prevalence rates of DVT in Ethiopia, but no comprehensive synthesis across the region.

• Common risk factors include advanced age, prolonged hospitalization, and prior DVT.

• DVT complications such as pulmonary embolism and chronic leg pain are well-documented.

What This Paper Adds.

• Provides a systematic review and meta-analysis, synthesizing data on DVT prevalence and risk factors in Ethiopia.

• Identifies additional local risk factors like central venous catheters and orthopedic trauma.

• Offers evidence-based recommendations for targeted prevention strategies and clinical protocols for the Ethiopian healthcare system.

• Enhances understanding of DVT in Ethiopia, laying the groundwork for future research, clinical practices, and public health initiatives.

Introduction

Deep Vein Thrombosis (DVT) is a severe medical condition involving blood clots in deep veins, often in the legs, leading to severe complications like pulmonary embolism, a life-threatening condition where the clot breaks off and travels to the lungs, causing a significant burden on global healthcare systems [1].

DVT is a global public health concern, affecting 1 to 2 cases per 1,000 persons annually [1], 2.4–9.6% in sub-Saharan Africa and 5% prevalence in Uganda and 2.4% in Nigeria and 9.6% in Sudan [2], with less than half of patients identified as at risk receive recommended prophylactic measures [3]. In Ethiopia, the prevalence of DVT varies by population group and clinical setting, ranging from 10.6 to 25.5% developed DVT [4,5,6,7,8,9,10,11].

DVT is a significant global health concern, affecting 10 million people annually and up to 900,000 in the US. It’s more prevalent among hospitalized patients, particularly those undergoing major surgeries or experiencing prolonged immobility. Over one-third of VTE cases are linked to recent hospitalizations, emphasizing the need for effective preventive measures [ 12 ]. Beyond the immediate health implications, it imposes a considerable economic burden on healthcare systems, the total cost burden was estimated at $41.28 billion, equating to $503 per patient at risk [ 13 ].

DVT can cause severe complications such as pulmonary embolism, post-thrombotic syndrome, chronic leg pain, swelling, and skin changes, increasing the risk of recurrence and causing long-term psychological stress due to fear of complications and ongoing treatment burden [4, 14].

The management and understanding of DVT face several critical gaps that hinder optimal patient outcomes, including underdiagnosis and delayed diagnosis, particularly in patients with atypical presentations or low clinical suspicion, leading to serious complications such as pulmonary embolism and post-thrombotic syndrome [15].

There is also a lack of awareness among healthcare providers and patients about DVT risk factors and early signs, especially in high-risk populations such as those undergoing surgery, cancer patients, and pregnant women [16]. Additionally, preventive strategies, including pharmacologic prophylaxis and mechanical methods like compression stockings, are not always implemented effectively, particularly in low-resource settings [17].

In Ethiopia, inconsistent risk stratification and limited use of standard diagnostic tools such as ultrasound hinder early identification of high-risk DVT patients [18]. Diagnostic practices vary across studies, with many not consistently reporting the use of compression ultrasonography, the gold standard following clinical assessment, raising concerns about underdiagnoses or misclassification [19]. These discrepancies not only affect the accuracy of prevalence estimates but also limit comparability and contribute to suboptimal treatment outcomes due to variations in healthcare infrastructure and provider expertise [20].

Management of DVT is often neglected, and there is insufficient research on long-term treatment and rehabilitation strategies for DVT complications [21]. The psychosocial impact of DVT, including anxiety and depression related to the burden of ongoing treatment, is often overlooked, highlighting the need for better psychological support for these patients [22]. These gaps underscore the need for improved education, standardized protocols, better access to care, and increased research efforts in DVT diagnosis, prevention, and management.

This study differs from previous narrative reviews and individual studies in Ethiopia by providing the first comprehensive systematic review and meta-analysis that synthesizes evidence on the prevalence, associated risk factors, complications, and management of DVT across diverse populations and clinical settings in the country. This study aims to fill this gap by reviewing local data, which will help inform targeted prevention strategies, improve clinical practices, and guide public health policy. The findings will support evidence-based management and provide a foundation for further research, policy development, and tailored DVT protocols in Ethiopia.

Methods

Aim of the review

This systematic review aims to synthesize existing evidence on the prevalence, associated factors, diagnostic approaches, treatment strategies, and clinical outcomes of DVT in Ethiopia. It seeks to describe the demographic characteristics and risk factors of DVT patients, evaluate diagnostic methods and treatment modalities, and assess clinical outcomes such as recurrence and mortality rates.

Design of the study

This study employs a systematic review and meta-analysis design, adhering to PRISMA guidelines. A comprehensive search of multiple databases was conducted to identify relevant studies on DVT in Ethiopia. Studies were screened based on predefined eligibility criteria, data were extracted systematically, and methodological quality was assessed using validated tools. Meta-analysis was performed using R software, utilizing a random-effects model to estimate pooled prevalence, associated risk factors, treatment outcomes, and clinical complications. Heterogeneity was measured using the I² statistic, and publication bias was assessed using Egger’s test and funnel plots.

Research question

This systematic review examines DVT in Ethiopia, focusing on prevalence, risk factors, diagnostic modalities, treatment strategies, and clinical outcomes. It explores demographic characteristics, comorbidities, and healthcare access disparities. Additionally, it compares Ethiopian DVT data with global trends, identifying potential gaps in research and healthcare infrastructure to improve patient management and outcomes.

Inclusion and exclusion criteria

Included studies are published and unpublished observational and interventional research that provide data on DVT prevalence, risk factors, diagnostic methods, treatment approaches, and clinical outcomes in Ethiopia. Eligible studies must focus on DVT patients and report relevant demographic and clinical details. Peer-reviewed journal articles, dissertations, and gray literature were considered without restrictions on publication year. Excluded studies include case reports, expert opinions, conference abstracts, and studies lacking sufficient outcome data. Studies conducted outside Ethiopia or focusing solely on experimental models rather than human subjects are also excluded.

Search strategy

A systematic search was conducted across electronic databases, including PubMed, Scopus, Web of Science, Google Scholar, African Journals Online (AJOL), and Ethiopian university repositories. Search terms combined keywords and Medical Subject Headings (MeSH) such as “Deep Vein Thrombosis,” “DVT,” “Thrombus,” “Ethiopia,” “prevalence,” “risk factors,” “diagnosis,” “treatment,” and “clinical outcomes.” Additionally, reference lists of selected articles were manually reviewed to identify further studies. No restrictions on publication year were applied. Duplicate records were removed, and two independent reviewers screened articles for inclusion, resolving discrepancies through discussion. The database was searched for every article published on DVT till March 30, 2025, and continued to update until we sent it for publication. The data was extracted from March 10–15 and later analyzed from March 15–25, 2025, and the report generation until April 04, 2025 (Fig. 1). The review protocol was registered with PROSPERO on 06 April 2025 (Registration number: CRD420251024491).

Search outcomes

After conducting searches across the designated databases, a total of 76 publications (PubMed = 07, CINAHL = 03, Scopus = 36, Web of Science = 12, Google Scholar = 16, repository). Each publication was exported to Excel and imported into Zotero for data extraction and screening. Following the application of inclusion and exclusion criteria, duplicate records were removed, resulting in 14 original articles that underwent screening. From this pool, eight articles were selected for further evaluation based on their eligibility. Upon detailed review, eight articles met the inclusion criteria. All reviewers independently assessed the titles and abstracts of each peer-reviewed article to determine its eligibility. Any disagreements between the reviewers regarding study inclusion were resolved through discussion and consensus, and the process is summarized in Fig. 1.

Fig. 1

Flow chart diagram and PRISMA 2020 checklist describing the selection of studies for the systematic review and meta-analysis of Deep vein thrombosis in Ethiopia, 2025

Data extraction

Data extraction followed a structured format for consistency. Two independent reviewers collected study characteristics, including authors, publication year, study design, sample size, and setting in Ethiopia. Patient demographics such as age, gender, and comorbidities were recorded. Key clinical data included symptom presentation, severity, hospitalization duration, and diagnostic methods used. Treatment approaches, including anticoagulation therapy, compression therapy, and surgical interventions, were documented alongside their effectiveness. Clinical outcomes such as recurrence rates, complications, and mortality were analyzed. Any missing or unclear data led to reviewing sources or contacting authors for clarification.

Organizing, summarizing, and reporting results

The systematic review and meta-analysis findings are categorized into five key domains: prevalence, associated risk factors, diagnostic methods, treatment strategies, and clinical outcomes. The prevalence section summarizes reported rates of DVT in Ethiopian populations. The risk factors section highlights key determinants such as immobility, comorbidities, and lifestyle factors. The diagnostic methods section examines access to Doppler ultrasound, D-dimer testing, and clinical assessments. The treatment strategies section evaluates anticoagulation therapy, compression therapy, and surgical interventions. Finally, the clinical outcomes section assesses recurrence rates, complications, mortality, and long-term functional outcomes. Findings are reported using descriptive summaries, tables, and figures, with PRISMA guidelines guiding the reporting process (Table 1).

Table 1 Data extraction form for systematic review of DVT in Ethiopia, 2025

Quality appraisal

The methodological quality of the included studies was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Studies were evaluated based on selection criteria, population description, measurement validity, confounding control, and statistical analysis. Each study was rated for risk of bias (low, moderate, or high). Studies scoring 7–8 “Yes” responses were classified as low risk, 4–6 as moderate risk, and 0–3 as high risk. High-risk studies were excluded, while those with low or moderate risk were included. The quality appraisal results were summarized to interpret the reliability of the evidence (Table 2).

Table 2 JBI critical appraisal of included studies on DVT in ethiopia, 2025

Statistical analysis

Statistical analyses were conducted using R software. Descriptive statistics were used for summarizing prevalence, risk factors, diagnostic methods, treatment outcomes, and clinical complications. Continuous variables such as age and hospital stay were analyzed using means and standard deviations, while categorical variables were reported as frequencies and percentages. Meta-analysis was performed using a random-effects model to account for study variability. Key outcomes such as prevalence rates, treatment efficacy, and mortality were pooled. Heterogeneity was evaluated using the I² statistic (> 50% indicating substantial heterogeneity), and publication bias was assessed using funnel plots and Egger’s test. Sensitivity analyses were performed by excluding studies with high bias risk or small sample sizes. Results were reported with 95% confidence intervals and a significance level of p < 0.05, integrating findings with a narrative summary to enhance understanding of DVT in Ethiopia.

Ethical considerations

This systematic review and meta-analysis utilized secondary data from published studies, thereby not requiring direct ethical approval from an institutional review board. However, ethical principles were strictly adhered to throughout the research process. All included studies were reviewed to ensure compliance with ethical standards, including informed consent, confidentiality, and ethical approval where applicable. To maintain research integrity, only peer-reviewed and scientifically valid studies were included. Transparency and objectivity were prioritized by accurately reporting results, acknowledging limitations, and disclosing any potential conflicts of interest. Proper citation and attribution were ensured to respect the intellectual property rights of the original authors. By following these ethical guidelines, this study upholds the highest standards of academic and scientific research.

Result

Study selection

The selection of studies followed a systematic approach. Initially, 72 records were identified through database searching, and an additional four records were retrieved from other sources. After the removal of duplicates, 14 records remained for screening. During the screening phase, 06 records were excluded based on predefined eligibility criteria. The remaining eight full-text articles were assessed for eligibility, and none were excluded at this stage. As a result, a total of eight studies were included in the final quantitative synthesis (meta-analysis), with their full detailed description of each study summarized in Table (Table 1).

Characteristics of the reviewed studies

Eight original research studies on DVT in Ethiopia were included in this systematic review, covering diverse clinical settings across the country [4,5,6,7,8,9,10,11]. These studies were conducted in major hospitals such as Hawassa University Comprehensive Specialized Hospital [11], Tibebe Ghion Specialized Hospital in Bahir Dar [8], Debre Markos Comprehensive Specialized Hospital [10], Jimma University Medical Center, St. Paul’s Hospital Millennium Medical College, and several others in Northwest [6] and Southwest Ethiopia [7] and including all Ethiopian tertiary hospitals [4, 5, 9].

The review included various study designs, retrospective cohort studies [7, 11], cross-sectional studies [5, 8,9,10], an observational study [6], and a prospective cohort study [4]. The total sample size across these studies was 1,986 DVT patients, with individual studies ranging from 70 to 1,068 participants. The follow-up periods for the cohort studies varied, with Dagnew et al. [6] reporting six months, Gelcho et al. [7] spanning four years, and Mitiku et al. Mulatu et al. [4, 10] followed patients for 90 days (Table 1).

The studies reveal the mean age of participants varies from 35.8 ± 15.54 years to 48.28 ± 14.54 years [4,5,6,7,8,9,10,11]. Regarding gender distribution, there is considerable variation. Alemu et al. [11] (52.1% male, 47.9% female), Birane et al. [9] (58% male, 42% female), Mengesha et al. [8] (83.7% male, 16.3% female), and Dagnew et al. [6] (54.5% Male, 45.5% Female) show dominance in male participants. Daba et al. [5] (58.2% female,41.8% male), Gelcho et al. [7]( 46.5% female,28.9% male), Mitiku et al. [10] (57.5% female, 42.5% male), and Mulatu et al. [4] (65.1% female, 34.9% male) show higher female proportions. The gender distribution across the studies reveals significant variation. For male participants, the proportion ranges from 28.9% in Gelcho et al. [7] to a high of 83.7% in Mengesha et al. [8]. On the other hand, for female participants, the proportion ranges from 34.9 to 65.1% in Mulatu et al. [4].

Prevalence of deep vein thrombosis in Ethiopia

The study on the prevalence of DVT utilized a random-effects model with eight included studies, estimating a prevalence of 5.6% (SE = 0.0142, p < 0.001), with a confidence interval (CI; 2.9, 8.5). Heterogeneity analysis indicated minimal variability among studies (Tau² = 0, I² = 0.02%, Q = 8.110, p = 0.323), suggesting consistent findings across datasets. Model fit statistics, including AIC (-14.278) and BIC (-14.119), confirmed the robustness of the model (Fig. 2).

Fig. 2

Forest plot that shows a pooled mortality rate of deep vein thrombosis in Ethiopia, Systematic Review and Meta-analysis, 2025

The publication bias assessment showed no significant small-study effects, with Egger’s regression (p = 0.211) and Kendall’s Tau (p = 0.179) confirming the robustness of the findings. The Fail-Safe N analysis indicated that 34 null studies would be needed to overturn the results. Equivalence testing (Z = -31.139, p < 0.001) and influence diagnostics confirmed the stability of the pooled estimate. Additionally, the funnel plot showed no strong asymmetry, suggesting no substantial publication bias, further reinforcing the reliability of the prevalence estimate for deep vein thrombosis (DVT) (Fig. 3).

Fig. 3

Funnel plot that shows risk bias assessment of prevalence rate of DVT in Ethiopia, Systematic Review and Meta-analysis, 2025

Sensitivity analysis

A sensitivity analysis (leave-one-out approach) was performed to see how omitting each study affects the pooled prevalence estimate of DVT in Ethiopia. The pooled prevalence remains fairly consistent when each study is removed individually, ranging from 4.92 to 5.93%. This demonstrates that no single study excessively influences the overall estimate, suggesting the robustness of the pooled result (Table 3).

Table 3 Sensitivity analysis of pooled DVT prevalence (Leave-One-Out Method), Ethiopia, 2025

Mortality rate of deep vein thrombosis in Ethiopia

The mortality rate analysis, based on a random-effects model with eight studies, estimated an overall mortality rate of 5% with a standard error of 0.0142 and confidence interval (CI: 3, 8), and the result was statistically significant (p < 0.001). Heterogeneity analysis indicated minimal variation across studies, with an I² value of 0% and a Q-statistic p-value of 1.000, suggesting no substantial between-study variability (Fig. 4).

Fig. 4

Forest plot that shows the Mortality rate of DVT in Ethiopia, Systematic Review and Meta-analysis, 2025

The publication bias assessment showed mixed results. The Fail-Safe N (15, p = 0.003) suggested a potential risk of bias, but Kendall’s Tau (p = 1.000) and Egger’s regression (p = 0.963) indicated no significant small-study effects. The funnel plot appeared symmetrical, further supporting the absence of strong bias. Overall, while some concern exists, statistical tests and visual analysis do not confirm substantial publication bias (Fig. 5).

Fig. 5

Funnel plot that shows the Mortality rate of DVT in Ethiopia, Systematic Review and Meta-analysis, 2025

Recurrence rate of deep vein thrombosis in Ethiopia

The review included eight studies and estimated an overall effect size of the recurrence rate of DVT was 7.15% with a confidence interval (CI: 2, 12). A significant Z-value of 2.79 (p = 0.005) indicates a statistically significant effect. The confidence interval ranged from 0.021 to 0.122, confirming the robustness of the estimate. Heterogeneity analysis revealed minimal variation across studies, with a tau² value of 0, tau of 0.001, and an I² of 0.01%, suggesting that nearly all variability in effect sizes is due to sampling error rather than true heterogeneity (Fig. 6).

Fig. 6

Forest plot that shows recurrence rate of DVT in Ethiopia, Systematic Review and Meta-analysis, 2025

The publication bias analysis suggests minimal risk of bias. The Fail-Safe N test indicates that 24 null studies would be needed to negate the observed effect, while Egger’s regression (p = 0.079) and Kendall’s Tau (p = 0.109) show no strong evidence of asymmetry. The forest plot displays consistent effect sizes with minimal heterogeneity (I² = 0.01%) and overlapping confidence intervals. Additionally, the funnel plot appears symmetrical, further suggesting that publication bias is unlikely to have significantly influenced the results. Overall, the findings remain stable and reliable (Fig. 7).

Fig. 7

Funnel plot that shows the recurrence rate of DVT in Ethiopia, Systematic Review and Meta-analysis, 2025

Clinical characteristics of deep vein thrombosis

The systematic review revealed that pain and swelling are the most consistent and prominent symptoms of Deep Vein Thrombosis (DVT), reported in 100% of cases in several studies. Other common signs include pitting edema (77.9%), skin discoloration (57.1%), and local tenderness (53.7%) [4, 6, 9,10,11].

Anatomically, unilateral DVT was observed in 44.3% of cases, while bilateral involvement occurred in 38.5%. The lower limbs were most frequently affected, accounting for 95.3% of cases. Regarding the site of thrombosis, 62.8% had lower-extremity DVT and 37.1% had upper-extremity DVT. In terms of location, proximal DVT was present in 40.4%, distal DVT in 2.7%, and both proximal and distal involvement in 56.9% [4, 6, 9,10,11]. The mean hospital stay after admission ranges from 5 to 19 days [4, 6,7,8, 10, 11].

Causes and risk factors of deep vein thrombosis

The most common causes of DVT include surgery (34.4%) and central catheterization (39.2%), mechanical ventilation, orthopedic trauma, cancer, smoking, blood transfusion, and COVID-19 infection [5, 6, 9,10,11]. Pregnancy-related conditions, including postpartum status and abortion, are also linked to DVT [5, 6, 9,10,11]. Additionally, 23% of cases are classified as unprovoked DVT, where no clear cause is identified [6].

Risk factors that increase DVT susceptibility include prolonged hospital stays (29.9%), previous surgery (27.5%), active cancer (21.1%), prior venous thromboembolism (VTE) (20.6%), and acute infections (19.6%) [5, 6, 9, 11]. Other contributing factors include pregnancy, heart failure, prior trauma, genetic disorders, and advanced age (≥ 75 years) [6]. Patients with a history of central catheter use, previous DVT, high cholesterol, alcohol consumption, and inter-hospital transfers are also at higher risk [4]. Furthermore, improper anticoagulant dosing and potential drug interactions have been identified as additional risk factors [8].

Diagnostic methods used for deep vein thrombosis

Doppler ultrasonography is frequently used for diagnostic purposes in studies, often combined with clinical assessments or other imaging techniques such as X-ray, CT-scan, and MRI, depending on the condition being assessed [4,5,6,7,8,9,10,11]. Diagnostic tools are available but limited in remote and rural areas [4,5,6, 9,10,11], with unequal distribution across hospitals [6]. Hereditary thrombophilia testing is unavailable [4].

Deep vein thrombosis treatment approach and its complications

The reviews show a majority of patients receive warfarin, followed by unfractionated heparin and other medications like enoxaparin, rivaroxaban, and Antivitamin [4,5,6, 9,10,11]. Access to anticoagulation therapy is often limited due to cost and availability issues, with financial and logistical barriers impacting treatment [4,5,6, 9,10,11]. Treatment outcomes for DVT as complete cure rates ranged from 4–24.65% [4, 6, 7, 9, 11]. Pulmonary embolism (PE) accounts for 44.4% of cases [4, 5, 9, 11]. Post-thrombotic syndrome (PTS) in 38.3%, and chronic venous insufficiency in 17.3% of cases [9].

Barriers to early diagnosis and challenges in DVT management

Barriers to early DVT diagnosis include a lack of guidelines, limited awareness, delayed hospital visits, financial constraints, and a shortage of specialists [4,5,6, 9,10,11]. DVT management is challenged by issues like failure to achieve therapeutic aPTT levels and inappropriate thromboprophylaxis use [6, 11], poor follow-up [9], and non-adherence to anticoagulation [5], lack of standardized guidelines [9, 11]. Factors such as smoking, alcohol, immobilization, and limited anticoagulant access and diagnostic resources further complicate treatment [4,5,6,7, 9,10,11].

Factors associated with deep vein thrombosis in Ethiopia

Only one study by Gelcho et al. [7] shows an association between the development of DVT and Gender, as being a male is associated with a higher risk of developing deep vein thrombosis (DVT). The adjusted odds ratio (AOR) for males was 1.292 (95% CI: 1.008–1.654), indicating a significantly increased risk compared to females (p = 0.043).

A total of three studies were pooled to assess the significant association between age-related factors and the development of Deep Vein Thrombosis (DVT) [4, 8, 9]. The overall effect showed that individuals with advanced age or age-related risks are approximately 9.45 times more likely to develop DVT at 95% CI (2.9, 16) (Fig. 8).

Fig. 8

A forest Plot that shows an association between Age and the Development of DVT in Ethiopia: Systematic review and Meta-analysis, 2025

A total of four studies were pooled to assess the significant association between length of hospital stay and the development of Deep Vein Thrombosis (DVT), which shows patients hospitalized for more than two weeks are nearly three times more likely to develop DVT compared to those with shorter stays at 95% CI (1.13, 7.93) (Fig. 9).

Fig. 9

A funnel plot that shows an association between length of hospital stay and the Development of DVT in Ethiopia: Systematic review and Meta-analysis, 2025

A study done by Mitiku et al. [10] shows patients transferred from other hospitals had a markedly increased risk of developing DVT (AOR = 43.24, Pvalue < 0.001)and a study done by Dagnew et al. [6]reported that patients admitted to the ICU had an elevated risk of DVT (AOR = 4.28, CI: 1.878, 16.134, P value < 0.001), that participant not immobilized has increased odds of development of DVT as shown in the study done by Gelcho et al. [7] (AOR = 1.873, CI: 1.352, 2.596, P value < 0.001). Additionally, a study done by Mulatu et al. [4] identified those pregnant women as two times more likely to have a Development of DVT than nonpregnant women (AOR = 2.091, CI: 1.046, 4.179,p = 0.037).

A study by Mitiku et al. [10] showed that the presence of a central venous catheter was strongly associated with the outcome of interest (AOR = 12.92, p value = 0.001). Additionally, having cholesterol levels above normal was also significantly associated with the outcome, with an AOR of 3.843 and a p-value of 0.001. Alemu et al. [11] identified a significant association between orthopedic trauma and the development of deep vein thrombosis (DVT). Patients who experienced orthopedic trauma had 2.6 times higher odds of developing DVT (AOR = 2.6, CI: 1.2–5.4, a p-value of 0.014).

Several studies have identified significant comorbidities and conditions associated with the development of deep vein thrombosis (DVT) [4, 8, 9, 11]. According to Birhane et al. [9], hypertension was strongly linked with DVT(AOR = 6.5 (95% CI: 2.90–14.70, p < 0.001). Similarly, patients with an Injury Severity Score ≥ 15 were 33 times more likely to develop DVT (AOR = 33.08, 95% CI: 3.60–303.65, p < 0.05) as reported by Mengesha et al. [8]. Alemu et al. [11] also found that having COVID-19 significantly increased the odds of DVT (AOR = 2.5, 95% CI: 1.07–5.1, p = 0.034). In the same study by Mengesha et al. [8], having any comorbidity was associated with a higher risk of DVT (AOR = 8.62, 95% CI: 1.10–67.50, p < 0.05). Furthermore, Mulatu et al. [4]demonstrated that diabetes mellitus significantly increased the risk of DVT, with an AOR of 8.048 (95% CI: 2.494–25.966, p < 0.001).

Various studies have explored the relationship between alcohol consumption and the risk of developing deep vein thrombosis (DVT), yielding mixed findings. Gelcho et al. [7] reported that regular alcohol consumption was associated with a decreased risk of DVT (AOR = 0.555, 95% CI: 0.431–0.715, p < 0.001). In contrast, Mitiku et al. [10] found that regular alcohol consumption increased the odds of DVT (AOR = 4.596, p = 0.032). Mulatu et al. [4] reported that occasional alcohol consumption was linked with a higher hazard of DVT (AHR = 2.011, 95% CI: 0.701–5.768, p = 0.019), while ex-alcohol users had significantly lower odds (AOR = 0.098, 95% CI: 0.011–0.870, p = 0.037).

Birhane et al. [9] found that obesity was significantly associated with an increased risk of developing deep vein thrombosis (DVT). Individuals with obesity had 3.3 times higher odds of developing DVT compared to non-obese individuals (AOR = 3.3, 95% CI: 1.15–9.59, p = 0.027). The study by Mulatu et al. [4] indicated that failure to reach the activated partial thromboplastin time (aPTT) target within 24 h was significantly associated with the development of deep vein thrombosis (DVT). Patients who did not achieve the aPTT target within this timeframe had higher odds of developing DVT, with an Adjusted Odds Ratio (AOR 1.129, CI: 0.120–10.600, p = 0.011).

Two studies, Mulatu et al. [4] and Mitiku et al. [10], found a significant association between a previous history of deep vein thrombosis (DVT) and the risk of developing a recurrent DVT. Mulatu et al. [4] reported that individuals with a prior DVT had a 2.48 times higher hazard of recurrence (AOR = 2.48, 95% CI: 1.085–11.20, p = 0.0002). Similarly, Mitiku et al. [10] found an even stronger association (AOR = 28.32,p < 0.001), indicating a markedly increased likelihood of DVT recurrence in those with a previous history.

Two studies by Birhane et al. [9]and Daba et al. [5] found that bilateral deep vein thrombosis (DVT) is significantly associated with an increased risk of adverse outcomes. Birhane et al. (2024) reported an Adjusted Odds Ratio (AOR) of 2.8 (95% CI: 1.14–6.66, p = 0.024), suggesting that patients with bilateral DVT have 2.8 times higher odds of experiencing adverse outcomes compared to those with unilateral DVT. Similarly, Daba et al. (2016) found a stronger association, with an AOR of 3.94 (95% CI: 1.6–9.701, p = 0.003), indicating that individuals with bilateral DVT are nearly four times more likely to face complications.

Discussion

This systematic review and meta-analysis included nine studies conducted across various regions and clinical settings in Ethiopia, providing a comprehensive overview of the epidemiological characteristics of DVT in the country [4,5,6,7,8,9,10,11]. The included studies, with a total of 1,986 participants, used various designs and showed notable differences in age and gender distribution. This variation highlights the complex nature of DVT in Ethiopia and the need for tailored prevention and management strategies.

The pooled prevalence rate from eight studies was estimated at 5% (95% CI: 3–8%) for Deep Vein Thrombosis (DVT) in Ethiopia is higher compared to rates in developed countries like the USA (3.1-4.2%) [23, 24], Australia (0.59-2.3%) [25], and Italy (1–2%) [26], as well as other African nations (2.4%) [27]. This disparity may be attributed to several factors, including differences in healthcare systems, where advanced diagnostic tools and prevention strategies in developed countries lead to earlier detection and lower reported prevalence, along with limited healthcare access and awareness in Ethiopia could contribute to the higher prevalence. Differences in study design, such as a focus on hospitalized patients in Ethiopia, may also explain the variation in reported prevalence rates.

The pooled mortality rate from eight studies was estimated at 5.6% (95% CI: 2.9.8.5%) for Deep Vein Thrombosis (DVT) in Ethiopia is higher than global estimates by WHO( 0-2.4%) [28], and the rates reported in the USA (3.1-4.2%) [10, 11], UK (3.7%) [29], and Australia (0.59-2.3%) [25]. This disparity can be attributed to differences in healthcare systems, with developed countries benefiting from better access to timely diagnosis, preventive measures, and specialized care, which reduce mortality [30].

The review included eight studies and estimated an overall effect size of the recurrence rate of DVT was 7.15% with a confidence interval (95% CI, 2, 12). This rate is higher compared to studies conducted in developed countries, such as the UK, which report recurrence rates ranging from 1.9–4% [31], and the USA accounts for 0.4-1.5% [32]. These differences may be attributed to variations in healthcare access, preventive measures, and diagnostic capabilities across countries. The higher recurrence rate observed in the Ethiopian context may reflect challenges such as limited access to appropriate healthcare, insufficient prophylactic measures, and delayed detection and treatment.

The systematic review found that pain and swelling are the most consistent symptoms of Deep Vein Thrombosis (DVT), reported in 100% of cases in several studies, with other common signs including pitting edema (77.9%), skin discoloration (57.1%), and local tenderness (53.7%) [4, 6, 9,10,11]. These findings are consistent with studies conducted in other countries, such as the USA [33], Canada [34, 35], and the Netherlands [36], where pain and swelling were also identified as the most frequent symptoms, with similar prevalence rates. This suggests that these signs are universally reliable for diagnosing DVT across different populations and settings.

The reviewed article showed that unilateral DVT was observed in 44.3% of cases, while bilateral involvement occurred in 38.5%. The lower limbs were most frequently affected, accounting for 95.3% of cases, and proximal DVT was present in 40.4%, and both proximal and distal involvement in 56.9% [4, 6, 9,10,11]. These findings are similar to studies conducted in other regions, such as in China [37], which say lower-extremity DVT is predominant, and bilateral involvement is less common. In the USA [29] where lower-extremity involvement is most common, with a high prevalence of proximal DVT.

The review showed that surgery (34.4%) and central catheterization (39.2%) as the most common causes of DVT, followed by mechanical ventilation, orthopedic trauma, cancer, smoking, blood transfusion, COVID-19 infection, and pregnancy-related conditions (such as postpartum status and abortion [5, 6, 10, 11]. These findings align with global research as Central venous catheterization and pregnancy are associated with the development of DVT [38]. Understanding these risk factors is crucial for developing effective prevention and management strategies for DVT across diverse populations through implementing early mobilization, health education, and compression therapy.

This systematic review identified several key risk factors for DVT, including prolonged hospital stays, previous surgery, active cancer, prior venous thromboembolism (VTE), acute infections, pregnancy, heart failure, prior trauma, genetic disorders, advanced age, and a history of central catheter use, previous DVT, high cholesterol, alcohol consumption, and inter-hospital transfers. Additionally, improper anticoagulant dosing and drug interactions were noted as significant risks. This finding is similar to the CDC report shows Prolonged Hospital Stays and Surgery, Active Cancer, Prior Venous Thromboembolism, age, Central Catheter Use, Improper Anticoagulant Use, Genetic Clotting Disorders [39], Acute Infections, Pregnancy and Postpartum Period, and Obesity [40] can increase the risk of developing DVT. Implementing early mobilization, health education, compression therapy, and low-dose anticoagulants can effectively reduce DVT risk in resource-limited settings like Ethiopia.

The systematic review indicates that Doppler ultrasonography was the most commonly used diagnostic tool for DVT across the included studies [4,5,6,7,8,9,10,11]. However, the exact percentage of patients who received ultrasonography measurement was not consistently reported and could not be calculated [4,5,6,7,8,9,10,11]. While diagnostic tools are available in many healthcare settings, their accessibility is limited in remote and rural areas, with disparities in their distribution across hospitals [4,5,6, 9,10,11], which is similar to studies done in Norway [41] and the UK [42]. Additionally, hereditary thrombophilia testing, which could help in identifying underlying genetic predispositions to DVT, is largely unavailable in the reviewed studies [4]. These limitations emphasize the need for improving diagnostic infrastructure, particularly in underserved areas, to ensure timely and accurate diagnosis and management of DVT.

In this review, the treatment approach for DVT predominantly includes the use of warfarin, unfractionated heparin, and other anticoagulants such as enoxaparin and rivaroxaban [4,5,6, 9,10,11]. However, access to these therapies is often limited due to financial and logistical barriers, with cost and availability posing significant challenges to patients in low-resource settings [4,5,6, 9,10,11]. Moreover, complications associated with DVT, such as pulmonary embolism, post-thrombotic syndrome, and chronic venous insufficiency [4, 6, 7, 9, 11] highlight the substantial burden of the disease on affected individuals. To mitigate this, the Ethiopian treatment strategy for DVT should start with unfractionated heparin, long-term warfarin, regular INR monitoring, and enoxaparin if available, with strengthened supply and essential drug listing.

A reviewed article showed significant barriers to early diagnosis and timely management of DVT as a lack of standardized clinical guidelines, limited awareness among healthcare providers, delayed hospital visits, and a shortage of specialists in rural areas [4,5,6,7, 9,10,11]. The barriers to diagnosis and management identified in this review are consistent with findings from other low- and middle-income countries, where healthcare access and resources are limited [43]. Additionally, challenges in DVT management are exacerbated by issues such as the failure to achieve therapeutic activated partial thromboplastin time (aPTT) levels, inappropriate thromboprophylaxis use, and poor follow-up [4,5,6,7, 9,10,11]. To improve outcomes, healthcare workers should have to standardize guidelines, increase provider awareness, and enhance access to diagnostic tools and specialists, particularly in low-resource settings.

The study by Gelcho et al. [7] found a statistically significant association between male gender and increased risk of developing deep vein thrombosis (DVT), as males were approximately 29% more likely to develop DVT compared to females. This finding aligns with several studies conducted in Canada [44],Germany [45],Netherland [46],China [47],India [48],USA [49]. However, contrasting results were found in some studies where female has the highest risk for the development of DVT than males, as a study done in Africa [50], the USA [51], China [52], and Japan [53]. More locally contextual and multi-center studies are recommended to validate gender-related differences in DVT risk.

A meta-analysis of three studies [4, 8, 9] found a significant association between age-related factors and the development of DVT. The results showed that individuals with advanced age or related risks are approximately 9.45 times more likely to develop DVT than quarter parts. The finding similar with study done in USA [54,55,56],china [57, 58],Ghana [59]. This is due to Advancing age has been identified as a key risk factor for DVT due to various physiological changes that occur with aging, including decreased venous return, reduced physical activity, and potential comorbid conditions such as cardiovascular disease, obesity, and diabetes [50]. Thus, healthcare systems implement targeted screening and prevention strategies for older adults to reduce DVT incidence.

The pooled analysis of four studies [6, 8, 10, 11] demonstrates a significant association between prolonged hospital stays and the development of DVT. Specifically, patients who remain hospitalized for more than two weeks are nearly three times more likely to develop DVT compared to those with shorter stays. Which is similar with other finding in USA [60], Jordon [61],Florida [62],India [63],Italy [64].This is due to prolonged hospitalization increases the risk of immobility, venous stasis, and underlying comorbidities, making them significantly more likely to develop DVT. To mitigate this risk, health professionals should implement early mobilization protocols, use prophylactic anticoagulation, and monitor high-risk patients for signs of DVT during extended hospital stays.

A study done by Mitiku et al. [10] shows patients transferred from other hospitals had a markedly increased risk of developing DVT which is similar to a study done in Florida [65], USA [66, 67]. This is due to underlying conditions or critical health states, delays in initiating DVT prophylaxis or mobilization, and disruption of care during the transfer process. Therefore, ensuring continuous care, early initiation of preventive measures, and careful monitoring during transfers can help reduce this elevated risk.

Dagnew et al. found that ICU patients have a higher risk of developing DVT [6], while Gelcho et al. found that participants not immobilized have a higher risk of developing DVT [7]. Both studies highlight the importance of immobilization in patient care, which is similar to studies done in Iran [68], India [69], Saudi Arabia [70], and China [71]. This is due to physiological mechanisms like prolonged immobility, hypoperfusion, underlying diseases, and bed rest exacerbating DVT formation. Implementing early mobilization protocols, mechanical prophylaxis, and pharmacologic interventions can reduce DVT risk, improve patient outcomes, and prevent complications.

A study done by Mulatu et al. [4] identified those pregnant women as two times more likely to have Development of DVT than nonpregnant women. This finding aligns with studies conducted in Canada [72], the USA [73, 74], Australia [75], Ireland [76], UK [77], which also report a significantly higher risk of DVT in pregnant women. This is due to physiological changes such as elevated levels of estrogen, increased blood volume, and venous stasis, making pregnancy a critical period for thromboembolic events. Regular screening for obesity, thrombosis history, and prolonged immobility is recommended. Prophylactic measures like compression stockings, low-dose anticoagulation therapy, and early mobilization should be considered.

The reviewed article by Mitiku et al. shows a significant association between the presence of a central venous catheter [7] and elevated cholesterol levels were significantly linked to DVT. Additionally, Alemu et al. [11] identified that patients with orthopedic trauma had 2.6 times higher odds of developing DVT. These findings highlight key risk factors for DVT, including central venous catheters, hypercholesterolemia, and orthopedic trauma. Prophylactic measures such as anticoagulation therapy, early mobilization, and careful monitoring of these high-risk groups are crucial for preventing DVT.

Four included studies have identified significant comorbidities and conditions associated with the development of deep vein thrombosis [4, 8, 9, 11]. According to Birhane et al. [9], hypertension was strongly linked with DVT, similar to studies done in China [78] and Saudi Arabia [79]. Mengesha et al. [8] highlight that patients with an Injury Severity Score ≥ 15 were 33 times more likely to develop DVT, which is in line with a study done in China [80]. Alemu et al. [11] also found that having COVID-19 significantly increased the odds of DVT in a study done in Indonesia [81], the USA [82], and Sweden [83]. Mulatu et al. [4] demonstrated that diabetes mellitus significantly increased the risk of DVT. Implement preventive strategies like prophylactic anticoagulation, regular monitoring, early mobilization, and device management in individuals with comorbidities to reduce DVT risk, screen for underlying conditions, and initiate timely interventions.

The link between alcohol consumption and the risk of developing DVT is complex, with mixed findings across studies. Mitiku et al. [10] found that regular alcohol consumption increased the odds of DVT. In contrast, Gelcho et al. [7] reported that regular alcohol consumption was found to decrease DVT risk, which is similar to the study done in the USA [84, 85], but studies done in Sweden [86] and China [87] show that alcohol has no relation with the development of DVT. Alcohol may impact DVT risk through blood clotting, endothelial function, and circulation. Further research is needed to understand the relationship and tailor preventive strategies for DVT risk assessment.

Birhane et al. [9] found that obesity was significantly associated with a 3.3 times increased risk of developing deep vein thrombosis which is similar to a study done in Romania [88], and Qatar [89]. Obesity is strongly linked to DVT, necessitating prevention and management strategies like weight management programs, regular physical activity, and early mobilization for hospitalized patients. Clinicians should assess DVT risk in obese patients.

The studies by Mulatu et al. [4] and Mitiku et al. [10] both identified a significant association between a previous history of Deep Vein Thrombosis (DVT) and an increased risk of developing recurrent DVT, which is similar to a study finding in France [90] and, USA [91]. This highlights the chronic nature of DVT risk, where individuals who have experienced a previous episode are at higher risk for recurrence. Preventive measures like anticoagulation therapy and lifestyle modifications like regular physical activity and weight management are crucial for managing the risk of recurrent DVT in high-risk individuals, improving circulation, and reducing thrombotic events.

The studies by Birhane et al. [9] and Daba et al. [5] both found a significant association between bilateral Deep Vein Thrombosis (DVT) and an increased risk of adverse outcomes of DVT, which is similar to a study finding done in Switzerland [92] and, Island [93]. Bilateral DVT is a severe clot formation that can cause venous stasis, pulmonary embolism, and chronic venous insufficiency. Early interventions, including anticoagulation therapy, regular monitoring, and lifestyle modifications, are crucial for improving circulation and reducing complications, ensuring long-term health.

Implications of the findings for Ethiopian healthcare practice

The findings underscore that DVT is a significant yet under-recognized threat to patient safety in Ethiopia, marked by high prevalence, mortality, and recurrence rates. This calls for urgent action within the healthcare system. Hospitals should integrate routine DVT risk assessments into standard patient care, especially for high-risk groups such as post-surgical patients, those with prolonged immobility, or prior DVT history. Early initiation of anticoagulation therapy, including the use of unfractionated heparin followed by warfarin with INR monitoring, should be prioritized to prevent complications. At the national level, there is a critical need for the development and enforcement of standardized clinical guidelines for DVT prevention and treatment. Additionally, improving access to diagnostic tools like Doppler ultrasound, ensuring a consistent supply of anticoagulants, and training healthcare providers in DVT management are essential steps. These interventions, if effectively implemented, could significantly reduce DVT-related morbidity and mortality across Ethiopia.

Strengths and limitations

This systematic review and meta-analysis synthesized findings from eight original studies on Deep Vein Thrombosis (DVT) in Ethiopia, offering a comprehensive overview of its prevalence and associated risk factors. The inclusion of studies from major hospitals across the country enhances the relevance of the findings to clinical practice in urban healthcare settings. Key risk factors identified included advanced age, prolonged hospitalization, and use of central venous catheters. Study quality was rigorously assessed using validated tools to ensure methodological robustness.

However, several limitations must be considered. The review excluded case reports, expert opinions, and studies lacking complete outcome data, which may have restricted the breadth of evidence. Most included studies were conducted in tertiary hospitals, potentially limiting the generalizability of findings to rural or primary care settings. Substantial heterogeneity was observed across studies due to variations in populations, diagnostic methods, and clinical settings. Although subgroup and sensitivity analyses were performed to address this, residual variability may influence the pooled estimates. Potential publication bias was also identified and may have impacted the overall findings.

Conclusion

This systematic review and meta-analysis found that the pooled prevalence of DVT in Ethiopia is 5.6%, with a mortality rate of 5% and a recurrence rate of 7.15%. The analysis identified several significant risk factors, including advanced age, prolonged hospital stays, previous history of DVT, comorbid conditions (such as hypertension and diabetes), surgery, ICU admission, pregnancy, and the use of central venous catheters. Bilateral DVT was also associated with a higher likelihood of complications. These findings emphasize the critical need for early risk identification, proactive prevention, and timely management to reduce DVT-related morbidity and mortality. It is strongly recommended that healthcare institutions incorporate routine DVT risk assessments into clinical practice, especially for high-risk patients such as those undergoing surgery or experiencing extended immobility. Additionally, national public health strategies should promote awareness of DVT risk factors and early warning signs. Further multicenter research and large-scale meta-analyses are essential to strengthen the evidence base and guide policy and clinical interventions across Ethiopia.