{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:02:50Z","timestamp":1780736570740,"version":"3.54.1"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Surgical site infections remain disproportionately common in low\u2010 and middle\u2010income countries (LMICs). We systematically reviewed and meta\u2010analyzed evidence comparing chlorhexidine\u2010alcohol (CHG\u2010ALC) and povidone\u2010iodine (PI) for preoperative skin antisepsis in abdominal surgery in LMICs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Following PRISMA guidelines, we searched PubMed, Scopus, Web of Science, and Lens.org from January 2015 to October 2025 for randomized trials and prospective cohort studies conducted in LMICs that compared CHG\u2010ALC with PI and reported SSI outcomes after abdominal surgery. Because some eligible studies included mixed wound classifications, we performed a primary pooled analysis across eligible abdominal procedures and a pre\u2010specified sensitivity analysis restricted to studies limited to clean\u2010contaminated wounds. Study\u2010level risk ratios (RRs) were pooled using a random effects model, and heterogeneity and publication bias were assessed using\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>\u03c4<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      , Cochran's\n                      <jats:italic>Q<\/jats:italic>\n                      statistics, Egger's regression, and funnel plot\u2013based methods.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifteen studies including 7459 patients were analyzed. Overall, CHG\u2010ALC was associated with a lower risk of SSI than PI (RR\u00a0=\u00a00.61, 95% CI 0.46\u20130.80;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001; and\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00%). This effect remained significant when the largest trial was excluded (RR\u00a0=\u00a00.58, 95% CI 0.46\u20130.71) and when analysis was restricted to studies enrolling only clean\u2010contaminated wounds (RR\u00a0=\u00a00.59, 95% CI 0.45\u20130.77;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00%). Regional subgroup analysis showed consistent benefit in South Asia (RR\u00a0=\u00a00.58, 95% CI 0.46\u20130.71;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00%), whereas evidence in sub\u2010Saharan Africa was inconclusive (RR\u00a0=\u00a00.88, 95% CI 0.35\u20132.21;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a090.8%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CHG\u2010ALC appears more effective than PI for reducing SSI after abdominal surgery in LMICs overall, with the most consistent evidence observed in South Asia. However, evidence from sub\u2010Saharan Africa remains limited and heterogeneous. These findings support context\u2010specific implementation and the need for additional African trials focused on abdominal procedures and clearly defined wound classes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70409","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T02:45:16Z","timestamp":1778553916000},"page":"1508-1519","source":"Crossref","is-referenced-by-count":0,"title":["Chlorhexidine\u2010Alcohol Versus Povidone\u2010Iodine for Surgical Site Infection Prevention in Abdominal Surgery in Low\u2010 and Middle\u2010Income Countries: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"50","author":[{"given":"John","family":"Turyagumanawe","sequence":"first","affiliation":[{"name":"Department of Surgery Kampala International University, Western Campus  Ishaka Bushenyi Uganda"},{"name":"Public Health Department Hoima Regional Referral Hospital  Hoima Uganda"},{"name":"Makerere University School of Public Health  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enock","family":"Mukiibi","sequence":"additional","affiliation":[{"name":"Department of Surgery Kampala International University, Western Campus  Ishaka Bushenyi Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2608-1033","authenticated-orcid":false,"given":"Jackson","family":"Kakooza","sequence":"additional","affiliation":[{"name":"Department of Surgery Kampala International University, Western Campus  Ishaka Bushenyi Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Mugenyi","sequence":"additional","affiliation":[{"name":"Department of Surgery Kampala International University, Western Campus  Ishaka Bushenyi Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bienfait V.","family":"Mumbere","sequence":"additional","affiliation":[{"name":"Department of Surgery Kampala International University, Western Campus  Ishaka Bushenyi Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abass Alao","family":"Safiriyu","sequence":"additional","affiliation":[{"name":"Department of Physiology Kampala International University, Western Campus  Ishaka Bushenyi Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Kiswezi","family":"Kazigo","sequence":"additional","affiliation":[{"name":"Department of Surgery Kampala International University, Western Campus  Ishaka Bushenyi Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umaru","family":"Kabuye","sequence":"additional","affiliation":[{"name":"Department of Surgery Kampala International University, Western Campus  Ishaka Bushenyi Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Bwaga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Hoima Regional Referral Hospital  Hoima Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Nyende","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Kampala International University, Western Campus  Ishaka Bushenyi Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sedrick","family":"Bukyana","sequence":"additional","affiliation":[{"name":"Department of Surgery Kampala International University, Western Campus  Ishaka Bushenyi Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Ibudi","sequence":"additional","affiliation":[{"name":"Department of Surgery Hoima Regional Referral Hospital  Hoima Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashid","family":"Naziru","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Islamic University in Uganda  Mbale Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Bitamazire","sequence":"additional","affiliation":[{"name":"Department of Surgery Hoima Regional Referral Hospital  Hoima Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8434-178X","authenticated-orcid":false,"given":"Catherine R.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Surgery St. Joseph's Hospital Kitovu  Masaka Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prosper","family":"Akankwasa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Kampala International University, Western Campus  Ishaka Bushenyi Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1294-2981","authenticated-orcid":false,"given":"Theoneste","family":"Hakizimana","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Kampala International University, Western Campus  Ishaka Bushenyi Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(21)01548\u20108"},{"key":"e_1_2_12_3_1","article-title":"Is chlorhexidine\u2010Gluconate Superior Than Povidone\u2010Iodine in Preventing Surgical Site Infections? A Multicenter Study","author":"Bibi S.","year":"2015","journal-title":"Journal of Pakistan Medical Association"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/js9.0000000000002024"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.21608\/bmfj.2022.119137.1539"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595\u2010014\u20101078\u2010y"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.18535\/jmscr\/v5i12.129"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063\u2010021\u201005490\u20104"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.69524\/sljm.v1i2.46"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.18203\/2320\u20101770.ijrcog20191181"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zrad160"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.18203\/2349\u20102902.isj20163180"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.3909\/riu0467"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.71000\/ijhr126"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2018.05.168"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.18410\/jebmh\/2017\/485"},{"key":"e_1_2_12_17_1","article-title":"A Cross Sectional Study to Evaluate if Chlorhexidine More Effective than Povidine Iodine in Controlling Surgical Site Infections","author":"Mukhtar Q.","year":"2019","journal-title":"Indo American Journal of Pharmaceutical Sciences"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.24018\/ejmed.2020.2.4.415"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.21275\/v4i12.NOV152442"},{"issue":"4","key":"e_1_2_12_20_1","first-page":"802","article-title":"Comparison Between Chlorhexidine\u2010Alcohol and Povidone\u2010Iodine in Preventing Surgical Site Infection in Clean Contaminated Cases","volume":"68","author":"Sufyan A.","year":"2018","journal-title":"Pakistan Armed Forces Medical Journal"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473\u20103099(18)30101\u20104"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000004076"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa0810988"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0904"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2214\u2010109x(15)70085\u20109"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70409","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.70409","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.70409","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:46:16Z","timestamp":1780735576000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.70409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/wjs.70409"],"URL":"https:\/\/doi.org\/10.1002\/wjs.70409","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]}}}