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 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.

scholarly journals Occupational tuberculosis in healthcare workers in sub-Saharan Africa: A systematic review

2018 ◽  
Vol 74 (3) ◽  
pp. 95-108 ◽  
Author(s):  
Faith O Alele ◽  
Richard C. Franklin ◽  
Theophilus I. Emeto ◽  
Peter Leggat
Keyword(s):  
Systematic Review ◽  
Healthcare Workers ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

2020 ◽  
Author(s):  
Joseph Benjamin Bangura ◽  
Shui-yuan Xiao ◽  
Dan Qiu ◽  
Feiyun Ouyang ◽  
Lei Chen
Keyword(s):  
Systematic Review ◽  
Health Systems ◽  
Immunization Coverage ◽  
Case Control ◽  
Sub Saharan Africa ◽  
Immunization Programs ◽  
Childhood Immunization ◽  
Cross Sectional ◽  
National Immunization ◽  
Sub Saharan

Abstract Background Immunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa. Method This systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in Sub-Saharan Africa from January 1988 to February 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control. Results Of the 2,538 items identified, 40 met inclusion criteria. Parents/caretakers were the most common subjects. Eight articles were of moderate and 32 were of high methodological quality. Seven studies analyzed secondary data; 30 used cross-sectional designs and three employed case control method. Twenty-five studies reported national immunization coverage of key vaccines for children under one, fifteen did not. When reported, national immunization coverages of childhood vaccines were reported to be low. Parents/caretaker’s barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of off-springs, life style, migration and occupation. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines. Conclusion In this review we identified more thoroughly the parents/caretakers’ barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-economic and socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across Sub-Saharan Africa.

scholarly journals Health systems constraints and facilitators of human papillomavirus immunization programmes in sub-Saharan Africa: a systematic review

2020 ◽  
Vol 35 (6) ◽  
pp. 701-717 ◽  
Author(s):  
Edina Amponsah-Dacosta ◽  
Benjamin M Kagina ◽  
Jill Olivier
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Human Papillomavirus ◽  
Health Systems ◽  
Data Extraction ◽  
Health Systems Strengthening ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
Significant Health ◽  
Immunization Programmes

Abstract Given the vast investments made in national immunization programmes (NIPs) and the significance of NIPs to public health, it is important to understand what influences the optimal performance of NIPs. It has been established that well-performing NIPs require enabling health systems. However, systematic evidence on how the performance of health systems impacts on NIPs is lacking, especially from sub-Saharan Africa. We conducted a qualitative systematic review to synthesize the available evidence on health systems constraints and facilitators of NIPs in sub-Saharan Africa, using human papillomavirus immunization programmes as a proxy. Fifty-four articles published between 2008 and 2018 were found to be eligible. Data extraction was guided by an analytical model on the interface between NIPs and health systems. A cross-cutting thematic analysis of the extracted data was performed. This systematic review provides evidence necessary for informing ongoing health systems strengthening initiatives in sub-Saharan Africa. There is evidence to suggest that NIPs in sub-Saharan Africa have surmounted significant health systems constraints and have achieved notable public health success. This success can be attributed to strong political endorsement for vaccines, clear governance structures and effective collaboration with global partners. Despite this, significant health systems constraints persist in service delivery, vaccine communication, community engagement, the capacity of the health workforce and sustainable financing. These constraints could derail further progress if not addressed through health systems strengthening efforts. There is a need to expand the research agenda to include the comprehensive evaluation of health systems constraints and facilitators of NIPs within sub-Saharan Africa.

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 The incidence and mortality of COVID-19 related TB infection in Sub-Saharan Africa: A systematic review and meta-analysis

2022 ◽  
Author(s):  
Jacques JL Tamuzi ◽  
Gomer Lulendo ◽  
Patrick Mbuesse
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Case Fatality ◽  
Sub Saharan Africa ◽  
Combination Method ◽  
Diagnostic Tools ◽  
Post Mortem ◽  
Incidence And Mortality ◽  
Meta Regression ◽  
Sub Saharan

Background Coronavirus disease 2019 (COVID-19) is also associated with other co-morbidities among with previous and current pulmonary tuberculosis (PTB). PTB is a risk factor for COVID-19, both in terms of severity and mortality, regardless of human immunodeficiency virus (HIV) status. However, there is less information available on COVID-19 associated with PTB in point of view incidence and mortality rates in sub-Saharan Africa (SSA) as a high burden TB region. This systematic review served to provide data synthesis of available evidence on COVID-19/PTB incidence and case fatality rates, and mortality rate found in clinical and post-mortem COVID-19/PTB diagnostics in SSA. Methods We conducted a systematic electronic search in the PubMed, Medline, Google Scholar, Medrxix and COVID-19 Global literature on coronavirus disease databases for studies including COVID-19 associated with PTB in sub-Saharan Africa. The main outcomes were the proportion of people with COVID-19 associated to current /or previous PTB and the case fatality associated to COVID-19/PTB. The combination method was based on methodological similarities in the included random effect model studies using Prometa 3 software. We further undertook sensitivity analysis and meta-regression. Results From the 548 references extracted by the literature search, 25 studies were selected and included in the meta-analysis with a total of 191, 250 COVID-19 infected patients and 11, 452 COVID-19 deaths. The pooled COVID-19/PTB incidence was 2% [1%-3%] and mortality of 10% [4%-20%]. The pooled estimates for case fatality rate among COVID-19/PTB were 6% [3%-11%] for clinical PTB diagnostic and 26% [14%-48%] for post-mortem PTB diagnostic. Meta-regression model including the effect sizes and cumulative COVID-19 cases (P= 0.032), HIV prevalence (P= 0.041) and TB incidence (P= 0.002) to explained high heterogeneity between studies. Conclusion As a summary, the incidence of TB associated with COVID-19 and case fatality rates are higher in SSA. However, COVID-19 associated to TB may be underreported in the studies conducted in SSA as the post-mortem TB diagnostic was higher. Large-scale cohort studies that adequately clear tool on previous and/or current TB diagnostic tools are required to confirmed COVID-19/TB incidence and case fatality in SSA.

scholarly journals Knowledge, attitudes, and perceptions of long-acting reversible contraceptive (LARC) methods among healthcare workers in sub-Saharan Africa: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Laura Rouncivell ◽  
Simbarashe Takuva ◽  
Neo Ledibane ◽  
Alfred Musekiwa ◽  
Trudy D Leong
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Healthcare Workers ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Contraceptive Device ◽  
Attitudes And Perceptions ◽  
Sub Saharan ◽  
Long Acting ◽  
Long Acting Reversible Contraceptive

ABSTRACTObjectiveTo assess the knowledge, attitudes, and perceptions (KAP) of long-acting reversible contraceptive (LARC) methods among healthcare workers (HCW’s) in sub-Saharan Africa (SSA).MethodsA systematic review and meta-analysis were conducted following the PRISMA methodology. Two authors independently searched three electronic databases for studies published between 2000 and January 2020 reporting on the KAP of LARC methods among HCW’s in SSA. Titles and abstracts were screened against eligibility criteria, data were extracted and the included studies were assessed for risk of bias. A meta-analysis of proportions for 11 pre-determined questions relating to LARC KAP was performed. Heterogeneity was explored using the I2-statistic and publication bias investigated using funnel plots and Egger’s tests.ResultsTwenty-two studies comprising of 11 272 HCW’s from 11 SSA countries were included. Forty-one percent (95% CI: 20%, 61%) of HCW’s had received intrauterine contraceptive device (IUCD) insertion training while 63% (95% CI: 44%, 81%) expressed a desire for training. Only 27% (95% CI: 18%, 36%) deemed IUCD appropriate for HIV-infected women. Restrictions for IUCD and injectables based on a minimum age were imposed by 56% (95% CI: 33%, 78%) and 60% (95% CI: 36%, 84%), respectively. Minimum parity restrictions were observed among 29% (95% CI: 9%, 50%) of HCW’s for IUCDs and 36% (95% CI: 16%, 56%) for injectable contraceptives. Heterogeneity was high and publication bias was present in two of the 11 questions.ConclusionThe systematic review and meta-analysis indicate that unnecessary provider-imposed restrictions may hinder the uptake of LARC methods by women in SSA.

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