The Incidence and Risk Factors of Carbon Monoxide Poisoning in the Middle East and North Africa: Systematic Review

Meshal S. Alberreet, Mazen S. Ferwana, Majid A. AlSalamah, Abdulaziz M. Alsegayyir, Abdullah I. Alhussaini, Yousef M. Alotaibi, Khalid A. Alamri, Abdulmohsin A. Almehizia, Tammam M. Alanazi, Abdulaziz M. Alkewaibeen


Background: Carbon monoxide poisoning (COP) represents a significant burden and potential cause of death. However, there are only a few studies about COP in Saudi Arabia despite its noticeable impact on the community.
Objective: This systematic review aimed to estimate the prevalence of COP at the level of Middle Eastern and North African region based on WHO distribution, with a particular interest to extrapolate the case fatality rate (CFR) and complications rates among COP victims.
Methods: By reviewing the databases (Cochrane Library, Pubmed, EMBASE, and CINAHL) in a strategic approach, the relevant studies were retrieved and reviewed independently. Studies were included based on a predefined set of criteria. The quality of each study was evaluated by the Newcastle-Ottawa Scale (NOS). Outcome measures included the incidence (the primary outcome), gender, age, mortality and complications rate, seasonal variations, geographical area, source, and mechanism of exposure.
Results: From 2489 citations, only thirteen studies met the eligibility criteria from five different countries. The date of publication of included studies ranged from 2000 to 2017. The mean sample size was 1483 victims. Most of the victims were females (64.24%). The mean age of the victims was 29.6 years old. The overall incidence of COP was estimated to be equal to 13.37 per 100,000 inhabitants per year. Most of the COP events happened in the winter. Gas heaters were the most frequent source.
Conclusion: COP is still a significant burden though it is potentially preventable. Policies and obligations need reevaluation, and public awareness should be raised.


Carbon monoxide poisoning; COP; Case fatality rate; Middle East and North Africa.

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