scholarly journals Pregnancy cohorts and biobanking in sub-Saharan Africa: a systematic review

2020 ◽  
Vol 5 (11) ◽  
pp. e003716
Author(s):  
Jeffrey N Bone ◽  
Kelly Pickerill ◽  
Mai-Lei Woo Kinshella ◽  
Marianne Vidler ◽  
Rachel Craik ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Collection ◽  
Grey Literature ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
Reference List ◽  
Inclusion Criteria ◽  
Discovery Science ◽  
Sub Saharan ◽  
Expert Input

BackgroundTechnological advances and high throughput biological assays can facilitate discovery science in biobanks from population cohorts, including pregnant women. Biological pathways associated with health outcomes differ depending on geography, and high-income country data may not generalise to low-resource settings. We conducted a systematic review to identify prospective pregnancy cohorts in sub-Saharan Africa (SSA) that include biobanked samples with potential to enhance discovery science opportunity.MethodsInclusion criteria were prospective data collection during pregnancy, with associated biobanking in SSA. Data sources included: scientific databases (with comprehensive search terms), grey literature, hand searching applicable reference lists and expert input. Results were screened in a three-stage process based on title, abstract and full text by two independent reviewers. The review is registered on PROSPERO (CRD42019147483).ResultsFourteen SSA studies met the inclusion criteria from database searches (n=8), reference list searches (n=2) and expert input (n=4). Three studies have ongoing data collection. The most represented countries were South Africa and Mozambique (Southern Africa) (n=3), Benin (Western Africa) (n=4) and Tanzania (Eastern Africa) (n=4); including an estimated 31 763 women. Samples commonly collected were blood, cord blood and placenta. Seven studies collected neonatal samples. Common clinical outcomes included maternal and perinatal mortality, malaria and preterm birth.ConclusionsIncreasingly numerous pregnancy cohorts in SSA that include biobanking are generating a uniquely valuable resource for collaborative discovery science, and improved understanding of the high regional risks of maternal, fetal and neonatal morbidity and mortality. Future studies should align protocols and consider their added value and distinct contributions.

scholarly journals Readiness of Sub-Saharan Africa Healthcare Systems for the New Pandemic, Diabetes: A Systematic Review

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Bernardo Nuche-Berenguer ◽  
Linda E. Kupfer
Keyword(s):  
Systematic Review ◽  
Health Systems ◽  
Diabetes Care ◽  
Healthcare Workers ◽  
Scale Up ◽  
Sub Saharan Africa ◽  
Diagnostic Tools ◽  
Inclusion Criteria ◽  
Care Health ◽  
Sub Saharan

Background. Effective health systems are needed to care for the coming surge of diabetics in sub-Saharan Africa (SSA). Objective. We conducted a systematic review of literature to determine the capacity of SSA health systems to manage diabetes. Methodology. We used three different databases (Embase, Scopus, and PubMed) to search for studies, published from 2004 to 2017, on diabetes care in SSA. Results. Fifty-five articles met the inclusion criteria, covering the different aspects related to diabetes care such as availability of drugs and diagnostic tools, the capacity of healthcare workers, and the integration of diabetes care into HIV and TB platforms. Conclusion. Although chronic care health systems in SSA have developed significantly in the last decade, the capacity for managing diabetes remains in its infancy. We identified pilot projects to enhance these capacities. The scale-up of these pilot interventions and the integration of diabetes care into existing robust chronic disease platforms may be a feasible approach to begin to tackle the upcoming pandemic in diabetes. Nonetheless, much more work needs to be done to address the health system-wide deficiencies in diabetes care. More research is also needed to determine how to integrate diabetes care into the healthcare system in SSA.

scholarly journals A Systematic Review of the Incremental Costs of Implementing a New Vaccine in the Expanded Program of Immunization in Sub-Saharan Africa

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831989454
Author(s):  
Joe Brew ◽  
Christophe Sauboin
Keyword(s):  
Systematic Review ◽  
Data Collection ◽  
Interquartile Range ◽  
Sub Saharan Africa ◽  
World Health ◽  
African Countries ◽  
Vaccine Type ◽  
Sub Saharan ◽  
Health Organization ◽  
The Cost

Background. The World Health Organization is planning a pilot introduction of a new malaria vaccine in three sub-Saharan African countries. To inform considerations about including a new vaccine in the vaccination program of those and other countries, estimates from the scientific literature of the incremental costs of doing so are important. Methods. A systematic review of scientific studies reporting the costs of recent vaccine programs in sub-Saharan countries was performed. The focus was to obtain from each study an estimate of the cost per dose of vaccine administered excluding the acquisition cost of the vaccine and wastage. Studies published between 2000 and 2018 and indexed on PubMed could be included and results were standardized to 2015 US dollars (US$). Results. After successive screening of 2119 titles, and 941 abstracts, 58 studies with 80 data points (combinations of country, vaccine type, and vaccination approach–routine v. campaign) were retained. Most studies used the so-called ingredients approach as costing method combining field data collection with documented unit prices per cost item. The categorization of cost items and the extent of detailed reporting varied widely. Across the studies, the mean and median cost per dose administered was US$1.68 and US$0.88 with an interquartile range of US$0.54 to US$2.31. Routine vaccination was more costly than campaigns, with mean cost per dose of US$1.99 and US$0.88, respectively. Conclusion. Across the studies, there was huge variation in the cost per dose delivered, between and within countries, even in studies using consistent data collection tools and analysis methods, and including many health facilities. For planning purposes, the interquartile range of US$0.54 to US$2.31 may be a sufficiently precise estimate.

scholarly journals Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e048022
Author(s):  
Animut Alebel ◽  
Daniel Demant ◽  
Pammla Petrucka ◽  
David Sibbritt
Keyword(s):  
Systematic Review ◽  
Effect Size ◽  
Grey Literature ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Significance Level ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Lost To Follow Up

IntroductionUndernutrition is considered a marker for poor prognosis among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where undernutrition and HIV are both highly prevalent. Evidence suggests that undernutrition (body mass index <18.5 kg/m2) is one of the main factors that significantly increases the risk of lost to follow-up (LTFU) in PLHIV. However, primary studies in SSA have reported inconsistent findings on the relationship between undernutrition and LTFU among adults living with HIV. To the best of our knowledge, no systematic review which aimed to summarise the available evidence. Hence, this review aims to determine the pooled effect of undernutrition on LTFU among adults living with HIV in SSA.Methods and analysisPubMed, EMBASE, Web of Science, Scopus, and, for grey literature, Google Scholar will be systematically searched to include relevant articles published since 2005. Studies reporting the effect of undernutrition on LTFU in adults living with HIV in SSA will be included. The Newcastle-Ottawa Scale will be used for quality assessment. Data from eligible studies will be extracted using a standardised data extraction tool. Heterogeneity between included studies will be assessed using Cochrane Q-test and I2 statistics. The Egger’s and Begg’s tests at a 5% significance level will be used to evaluate publication bias. As heterogeneity is anticipated, the pooled effect size will be estimated using a random-effects model. The final effect size will be reported using the adjusted HR with a 95% CI.Ethics and disseminationEthical approval is not required for a protocol for a systematic review. The results of this systematic review will be published in a peer-reviewed journal and will be publicly available.PROSPERO registration numberCRD42021277741.

scholarly journals Implementation of Medicines Pricing Policies In Sub-Saharan Africa: Systematic Review

2021 ◽  
Author(s):  
Augustina Koduah ◽  
Leonard Baatiema ◽  
Anna Cronin de Chavez ◽  
Anthony Danso-Appiah ◽  
Irene A Kretchy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Policy Implementation ◽  
Access To Medicines ◽  
Sub Saharan Africa ◽  
Essential Medicines ◽  
Inclusion Criteria ◽  
Policy Actors ◽  
Pricing Policies ◽  
Private And Public ◽  
Sub Saharan

Abstract Background: High medicine prices contribute to increasing cost of healthcare worldwide. Many patients with limited resources in sub-Saharan Africa (SSA), are confronted with out-of-pocket charges, constraining their access to medicines. Different medicine pricing policies are implemented to improve affordability and availability. However, evidence on the experiences of implementations of these policies in SSA settings appears limited. To bridge this knowledge gap, we reviewed published evidence and answered the question: what are the key determinants of implementation of medicines pricing policies in SSA countries? Methods: We identified policies, examined implementation processes, key actors involved, contextual influences on and impact of these policies. We searched five databases and grey literature; screening was done in two stages following clear inclusion criteria. A structured template guided the data extraction and data analysis followed thematic narrative synthesis. The review followed best practices and reported using PRISMA guidelines.Results: Of the 5595 studies identified, 32 met the inclusion criteria. The results showed fourteen pricing policies were implemented across SSA between 2003 and 2020. These were in four domains: targeted public subsides, regulatory frameworks and direct price control, generic medicine policies and purchasing policies. Main actors involved were government, wholesalers, manufacturers, retailers, professional bodies, community members and private and public health facilities. Key contextual barriers to implementation were: limited awareness about policies, lack of regulatory capacity, and lack of price transparency in external reference pricing process. Key facilitators were: favourable policy environment on essential medicines, strong political will, and international support. Evidence on effectiveness of these policies on reducing prices of, and improving access to, medicines were mixed. Reductions in prices were reported occasionally and implementation of medicine pricing policy sometimes led to improved availability and affordability to essential medicines.Conclusions: Implementation of medicine pricing policies in SSA shows some mixed evidence of improved availability and affordability to essential medicines. It is important to understand country-specific experiences, diversity of policy actors and contextual barriers and facilitators to policy implementation. Our study suggests three policy implications: avoiding ‘one-size-fits-all’ approach, engaging both private and public sector policy actors in policy implementation and continuously monitor implementation and effects of policies. Systematic review protocol registration: PROSPERO registration number CRD42020178166.

SOCIOECONOMIC STATUS AS A RISK FACTOR FOR HIV INFECTION IN WOMEN IN EAST, CENTRAL AND SOUTHERN AFRICA: A SYSTEMATIC REVIEW

2004 ◽  
Vol 37 (1) ◽  
pp. 1-36 ◽  
Author(s):  
JANET MAIA WOJCICKI
Keyword(s):  
Systematic Review ◽  
Socioeconomic Status ◽  
Hiv Infection ◽  
Southern Africa ◽  
Case Control ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
Low Ses ◽  
Causal Pathway ◽  
Sub Saharan

This is a critical, systematic review of the relationship between socioeconomic status (SES) and HIV infection in women in Southern, Central and Eastern Africa. In light of the interest in micro-credit programmes and other HIV prevention interventions structured to empower women through increasing women’s access to funds and education, this review examines the epidemiological and public health literature, which ascertains the association between low SES using different measurements of SES and risk of HIV infection in women. Also, given the focus on structural violence and poverty as factors driving the HIV epidemic at a structural/ecological level, as advocated by Paul Farmer and others, this study examines the extent to which differences in SES between individuals in areas with generalized poverty affect risk for SES. Out of 71 studies retrieved, 36 studies met the inclusion criteria including 30 cross-sectional, one case-control and five prospective cohort or nested case-control studies. Thirty-five studies used at least one measurement of female’s SES and fourteen also included a measurement of partner’s SES. Studies used variables measuring educational level, household income and occupation or employment status at the individual and neighbourhood level to ascertain SES. Of the 36 studies, fifteen found no association between SES and HIV infection, twelve found an association between high SES and HIV infection, eight found an association between low SES and HIV infection and one was mixed. In interpreting these results, this review examines the role of potential confounders and effect modifiers such as history of STDs, number of partners, living in urban or rural areas and time and location of study in sub-Saharan Africa. It is argued that STDs and number of partners are on the causal pathway under investigation between HIV and SES and should not be adjusted as confounders in any analysis. In conclusion, it is argued that in low-income sub-Saharan Africans countries, where poverty is widespread, increasing access to resources for women may initially increase risk of HIV or have no effect on risk-taking behaviours. In some parts of Southern Africa where per capita income is higher and within-country inequalities in wealth are greater, studies suggest that increasing SES may decrease risk. This review concludes that increased SES may have differential effects on married and unmarried women and further studies should use multiple measures of SES. Lastly, it is suggested that the partner’s SES (measured by education or income/employment) may be a stronger predictor of female HIV serostatus than measures of female SES.

scholarly journals Effect of female sex work-targeted community-based interventions along the HIV treatment cascade in sub-Saharan Africa: a systematic review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039495
Author(s):  
Lydia Atuhaire ◽  
Olatunji Adetokunboh ◽  
Constance Shumba ◽  
Peter S Nyasulu
Keyword(s):  
Systematic Review ◽  
Sex Work ◽  
Grey Literature ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Community Based Interventions ◽  
Community Based ◽  
Treatment Cascade ◽  
Hiv Treatment Cascade ◽  
Sub Saharan

IntroductionFemale sex workers (FSWs) are a known high-risk group that are at increased risk of HIV transmission due to exposure to multiple sexual partners and inability to negotiate safe sex attributed to challenging economic circumstances. Previous systematic reviews have examined the effectiveness of HIV interventions prioritising FSWs and have shown that targeted interventions improve access to HIV prevention and treatment services. Interventions that increase FSWs’ uptake of services are well documented; however, evidence on specific interventions aimed at improving FSWs’ continuity in HIV care along the treatment cascade is lacking. This systematic review aims to document the performance of community-based interventions along the HIV treatment cascade.Methods and analysisWe will use a sensitive search strategy for electronic bibliographic databases, bibliographies of included articles and grey literature sources. In addition, the Joint United Nations Programme on HIV/AIDS and the WHO websites, peer-reviewed conference papers and grey literature sources will be searched for additional reports of sex work programmes. We will include randomised controlled trials, cross-sectional surveys and cohort interventions where community-based HIV services were provided to FSWs and measure the performance of the HIV intervention on one or more cascade stages. We will conduct a systematic review of studies published from 2004 to present within the sub-Saharan Africa region. We will report quantitative study outcomes of HIV testing and diagnosis, linkage to care, initiation on antiretroviral therapy and viral suppression. We will analyse the data using the random-effects meta-analysis method, and funnel plots will be used to assess the publication bias.Ethics and disseminationThis systematic review will not require ethical approval; we will publish data from manuscripts. The results of this study will be disseminated in peer-reviewed journals and conference presentations.PROSPERO registration numberCRD42020157623.

scholarly journals Chronic care models and opportunities for improving health care practice and outcomes in Sub-Saharan Africa: Protocol for systematic review

2020 ◽  
Author(s):  
Peter Otieno ◽  
Charles Agyemang ◽  
Razak M. Gyasi ◽  
Anthony K. Ngugi ◽  
Catherine Kyobutungi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Chronic Care ◽  
Critical Appraisal ◽  
Health Care Systems ◽  
Grey Literature ◽  
Sub Saharan Africa ◽  
Care Models ◽  
Care Systems ◽  
Sub Saharan

Abstract Background: The rising burden of chronic diseases in sub-Saharan Africa (SSA) where health care systems are least developed has led to recent calls for increased investment in chronic care models (CCM) appropriate for low-resource settings. In SSA, limited resources are often allocated to treating acute diseases thus management of chronic conditions is a major challenge for health care systems. A large diversity of CCM exist in the literature but evidence supporting their use has been derived from high income settings. This is the motivation for conducting a systematic review to identify the existing CCM and their relevance and applicability in SSA.Methods and analysis: All peer-reviewed published and grey literature on CCM will be included. PubMed/MEDLINE, Embase, Scopus, Web of Science and Global Health Cinahl, African Journals Online, Informit Online, and PsycINFO will be searched to identify relevant articles. OpenSIGLE will be reviewed for grey literature. The articles retrieved will be independently screened for inclusion by two independent investigators while a third reviewer will arbitrate the disagreements. An independent critical appraisal of retrieved studies will be performed using standardized critical appraisal checklists. The data will be extracted from the key elements of CCM. Outcome measures for the effectiveness of the models in the context of SSA will include any reported improvement to the health care service delivery or changes in the health outcomes of patients with chronic illnesses. The study findings will be reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA).Discussion: This systematic review is expected to generate crucial evidence on the applicability of CCM in SSA and unearth the CCM components that are suitable for different levels of health care delivery systems and the emerging needs of the people living with comorbidities and multimorbidities in SSA.Systematic review registration: This review is registered in PROSPERO International Prospective Register of Systematic reviews CRD42020187756.

scholarly journals Menstrual hygiene practice and its determinants among Adolescent Girls in Sub-Saharan Africa. A systematic review and meta-analysis protocol

2021 ◽  
Author(s):  
Etsay Woldu Anbesu ◽  
Setognal Birara Aychiluhm
Keyword(s):  
Systematic Review ◽  
Adolescent Girls ◽  
Meta Analysis ◽  
Grey Literature ◽  
Random Effect Model ◽  
Sub Saharan Africa ◽  
Hygiene Practice ◽  
Menstrual Hygiene ◽  
Pooled Prevalence ◽  
Sub Saharan

Abstract Background: Poor menstrual hygiene practices can lead to gynecological problems, psychosocial stress, and reduced access to school. Menstrual hygiene has not received adequate attention in Sub-Saharan Africa. Moreover, there were fragmented and inconsistent findings. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of menstrual hygiene practice and identify its associated factors among adolescent girls in Sub-Saharan Africa.Methods: The protocol for this review had registered at PROSPERO with registration number: CRD42020165628. In this study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline will be used. Online electronic databases PubMed, Google Scholar, CINAHL and grey literature will be searched to retrieve available studies. Joanna Briggs Institute checklist will be used to assess the quality of the studies. Heterogeneity among studies will be examined using a chi-squared test and I-squared statistic.To investigate sources of heterogeneity, subgroup analyses and meta-regression will be performed. Sensitivity analysis will be conducted to identify influential studies. Publication bias will be examined by funnel plots and Egger’s test. The statistical analysis will be conducted using STATA version-16 software. A random-effect model will be used to estimate the pooled prevalence, and statistical significance will be determined at a p-value of <0.05.Discussion: Poor menstrual hygiene practice affects the health of millions of adolescent girls in developing countries. Currently, there are no synthesis research findings on the overall pooled prevalence of menstrual hygiene practice and its associated factor in Sub-Saharan Africa. Therefore, this systematic review and meta-analysis will be used to inform policy-makers, programmers, planners, clinicians, and researchers to design appropriate strategies.

scholarly journals Menstrual hygiene practice and its determinants among Adolescent Girls in Sub-Saharan Africa. A systematic review and meta-analysis protocol

2021 ◽  
Author(s):  
Etsay Woldu Anbesu ◽  
Setognal Birara Aychiluhm
Keyword(s):  
Systematic Review ◽  
Adolescent Girls ◽  
Meta Analysis ◽  
Grey Literature ◽  
Random Effect Model ◽  
Sub Saharan Africa ◽  
Hygiene Practice ◽  
Menstrual Hygiene ◽  
Pooled Prevalence ◽  
Sub Saharan

Abstract Background: Poor menstrual hygiene practices can lead to gynecological problems, psychosocial stress, and reduced access to school. Menstrual hygiene has not received adequate attention in Sub-Saharan Africa. Despite this, there are fragmented and inconsistent findings in Sub-Saharan Africa. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of good menstrual hygiene practice and identify its associated factors among adolescent girls in Sub-Saharan Africa. Methods: The protocol for this review was registered at PROSPERO with registration number: CRD42020165628. In this study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline will be used to report the protocol. Online electronic databases PubMed, Google Scholar, CINAHL and unpublished grey literature will be searched to retrieve available studies from January 1-May/2021. The selection, data extraction, and quality assessment of studies will be carried by two authors. Joanna Briggs Institute checklist will be used to assess the quality of the studies. Heterogeneity among studies will be examined using a chi-squared test and I-squared statistic. To investigate sources of heterogeneity, subgroup analyses and meta-regression will be done based on region and sample size. Sensitivity analysis will be conducted to identify influential studies. Publication bias will be examined by funnel plots and Egger’s test. The statistical analysis will be conducted using STATA version-14 software. A random-effect model will be used to estimate the pooled prevalence, and statistical significance will be determined at a p-value of <0.05.Discussion: Poor menstrual hygiene practice affects the health of millions of adolescent girls in developing countries. Currently, there are no synthesis research findings on the pooled prevalence of menstrual hygiene practice and its associated factor in Sub-Saharan Africa. Therefore, the findings of this systematic review and meta-analysis will be helpful to inform policy-makers, planners, and researchers to design appropriate interventions.

scholarly journals Effectiveness of climate change adaptation interventions in sub-Saharan Africa and the impact of funding modalities: a mixed methods systematic review protocol

2021 ◽  
Author(s):  
Biljana Macura ◽  
◽  
Nella Canales ◽  
Inès Bakhtaoui ◽  
Richard Taylor ◽  
...  
Keyword(s):  
Climate Change ◽  
Systematic Review ◽  
Mixed Methods ◽  
Greenhouse Gas Emission ◽  
Grey Literature ◽  
Climate Change Impacts ◽  
Sub Saharan Africa ◽  
Adaptation Measures ◽  
Sub Saharan ◽  
The Impact

International climate finance plays a key role in enabling the implementation of adaptation measures. However, while there is a common metric for gauging the effectiveness of finance for mitigation – greenhouse gas emission reduction per unit of funding – no corresponding metric exists for adaptation. Instead, assessments of what works best in adaptation finance focus either on procedural aspects of funding modalities, such as equity in the allocation of funding, or on the extent to which specific adaptation activities produce the desired results. This mixed methods systematic review aims to assess the effectiveness of adaptation finance and bridge the gap between those two approaches. It involves a transparent and comprehensive synthesis of the academic and grey literature on how different characteristics of adaptation projects in sub-Saharan Africa – and finance for those projects – affect adaptation outcomes, particularly in terms of risk and vulnerability to climate change impacts. Finalised adaptation projects funded by a set of the multilateral climate funds and two bilateral donors (United Kingdom and Sweden) are the focus of this review. The findings can help inform the future design and implementation of adaptation activities as well as funding decisions.

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