Acute coronary syndromes in sub-Saharan Africa: A ten-year systematic review

Background and Objectives: The majority of patients included in trials of anti-platelet therapy are male. This systematic review and meta-analysis aimed to determine whether, in addition to aspirin, P2Y12 blockade is beneficial in both women and men with acute coronary syndromes. Methods: Electronic databases were searched and nine eligible randomised controlled studies were identified that had sex-specific clinical outcomes (n=107,126 patients). Risk Ratios (RR) and 95% Confidence Intervals (CI) were calculated for a composite of cardiovascular death, myocardial infarction or stroke (MACE), and a safety endpoint of major bleeding for each sex. Indirect comparison analysis was performed to statistically compare ticagrelor against prasugrel. Results: Compared to aspirin alone, clopidogrel reduced MACE in men (RR, 0.79; 95% CI, 0.68 to 0.92; p=0.003), but was not statistically significant in women (RR, 0.88; 95% CI, 0.75 to 1.02, p=0.08). Clopidogrel therapy significantly increased bleeding in women but not men. Compared to clopidogrel, prasugrel was beneficial in men (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02) but not statistically significant in women (RR, 0.94; 95% CI, 0.83 to 1.06; p=0.30); ticagrelor reduced MACE in both men (RR, 0.85; 95% CI, 0.77 to 0.94; p=0.001) and women (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02). Indirect comparison demonstrated no significant difference between ticagrelor and prasugrel in either sex. Compared to clopidogrel, ticagrelor and prasugrel increased bleeding risk in both women and men. Conclusion: In summary, in comparison to monotherapy with aspirin, P2Y12 inhibitors reduce MACE in women and men. Ticagrelor was shown to be superior to clopidogrel in both sexes. Prasugrel showed a statistically significant benefit only in men; however indirect comparison did not demonstrate superiority of ticagrelor over prasugrel in women.

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Khat chewing and risky sexual behavior in Sub-Saharan Africa: a systematic review protocol

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/jbisrir-2013-877 ◽

2013 ◽

Vol 11 (12) ◽

pp. 59-67 ◽

Cited By ~ 4

Author(s):

Amanuel Tesfay Gebremedhin ◽

Hailay Abrha Gesesew ◽

Tariku Dejene Demissie ◽

Mirkuzie Woldie Kerie ◽

Morankar Sudhakar

Keyword(s):

Systematic Review ◽

Sexual Behavior ◽

Risky Sexual Behavior ◽

Sub Saharan Africa ◽

Systematic Review Protocol ◽

Khat Chewing ◽

Review Protocol ◽

Sub Saharan

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Gambling Patterns and Problem Gambling Among Youth in Sub-Saharan Africa: A Systematic Review

Journal of Gambling Studies ◽

10.1007/s10899-021-10001-w ◽

2021 ◽

Author(s):

Byron K. Y. Bitanihirwe ◽

Derrick Ssewanyana

Keyword(s):

Systematic Review ◽

Problem Gambling ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Gambling Patterns

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Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00822-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Hafte Kahsay Kebede ◽

Lillian Mwanri ◽

Paul Ward ◽

Hailay Abrha Gesesew

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Hiv Care ◽

Care Services ◽

Validity Assessment ◽

Sub Saharan ◽

Lost To Follow Up

Abstract Background It is known that ‘drop out’ from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. Methods We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. Results Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1–1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1–1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2–1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5–2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04–1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2–25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9–4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6–4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2–5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5–3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1–1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02–1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7–2.8, I2 = 75%). Conclusions The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418

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Behavioural interventions promoting condom use among female sex workers in sub-Saharan Africa: a systematic review

African Journal of AIDS Research ◽

10.2989/16085906.2017.1358753 ◽

2017 ◽

Vol 16 (3) ◽

pp. 257-268 ◽

Cited By ~ 7

Author(s):

Uchenna O Okafor ◽

Rik Crutzen ◽

Yauri Aduak ◽

Sylvia Adebajo ◽

Hubertus W Van den Borne

Keyword(s):

Systematic Review ◽

Condom Use ◽

Sex Workers ◽

Female Sex Workers ◽

Sub Saharan Africa ◽

Behavioural Interventions ◽

Female Sex ◽

Sub Saharan

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Interventions to Improve Adherence to Antiretroviral Therapy (ART) in Sub-Saharan Africa: An Updated Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052477 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2477

Author(s):

Panmial Priscilla Damulak ◽

Suriani Ismail ◽

Rosliza Abdul Manaf ◽

Salmiah Mohd Said ◽

Oche Agbaji

Keyword(s):

Systematic Review ◽

Antiretroviral Therapy ◽

Behavioral Interventions ◽

Controlled Trial ◽

Self Report ◽

Sub Saharan Africa ◽

Art Adherence ◽

Study Characteristics ◽

Combination Study ◽

Sub Saharan

Optimal adherence to antiretroviral therapy (ART) remains the bedrock of effective therapy and management of human immunodeficiency virus (HIV). This systematic review examines the effect of interventions in improving ART adherence in sub-Saharan Africa (SSA), which bears the largest global burden of HIV infection. In accordance with PRISMA guidelines, and based on our inclusion and exclusion criteria, PUBMED, MEDLINE, and Google Scholar databases were searched for published studies on ART adherence interventions from 2010 to 2019. Thirty-one eligible studies published between 2010 to 2019 were identified, the categories of interventions were structural, behavioral, biological, cognitive, and combination. Study characteristics varied across design, intervention type, intervention setting, country, and outcome measurements. Many of the studies were behavioral interventions conducted in hospitals with more studies being randomized controlled trial (RCT) interventions. Despite the study variations, twenty-four studies recorded improvements. Notwithstanding, more quality studies such as RCTs should be conducted, especially among key affected populations (KAPs) to control transmission of resistant strains of the virus. Reliable objective measures of adherence should replace the conventional subjective self-report. Furthermore, long-term interventions with longer duration should be considered when evaluating the effectiveness of interventions.

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