In-hospital mortality and its predictors among stroke patients in sub-Saharan Africa: A systemic review and meta-analysis

Objective: To assess the in-hospital mortality from acute stroke and its predictors in sub-Saharan Africa. Method: The literature search was conducted in the databases of PubMed/Medline, Embase, CINAHL, and Google Scholar. The retrieved studies were screened by titles and abstracts, and then full texts were assessed for eligibility. The methodological quality of the included studies was assessed using the Joanna Briggs Institute’s critical appraisal checklist. The publication bias was assessed using the funnel plot asymmetry and the Egger tests. Data were analyzed using Stata software version 15.0 in a random-effect model. Result: A total of 27 studies with a total sample size of 6331 were included in this systematic review and meta-analysis. The pooled estimated prevalence of in-hospital mortality due to stroke was 22% (95% confidence interval = 0.17–0.27). Stroke mortality in Western Africa (37%, 95% confidence interval = 0.24–0.50) was higher than in Eastern Africa (15%, 95% confidence interval = 0.12–0.19) and Southern Africa (18%, 95% confidence interval = 0.06–0.19). In three studies, mortality was higher in hemorrhagic stroke (25%) than ischemic stroke (14%). Risk factors associated with higher mortality were admission Glasgow Coma Scale, stroke severity, age, sex, presence of hypertension, and declined renal function. Conclusion: The in-patient mortality of stroke in sub-Saharan Africa was high. Therefore, there is an urgent need for further stroke epidemiology studies in stroke subtypes and the performance of patient-level meta-analysis to understand the risk factors associated with mortality and herald appropriate intervention to curb the high mortality rate in the region.

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Neonatal Septicaemia in Sub-Saharan Africa: A Protocol for Systematic Review and Meta-analysis.

10.21203/rs.3.rs-112780/v1 ◽

2020 ◽

Author(s):

Micheal Abel Alao ◽

Oluwakemi O Tongo ◽

Idowu Adejumoke Ayede ◽

Michael Udochukwu Diala ◽

Olayinka Rasheed Ibrahim ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Hospital Mortality ◽

Observational Studies ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Sub Saharan Africa ◽

Bacterial Isolates ◽

Neonatal Septicaemia ◽

Sub Saharan

Abstract Background: The morbidity and mortality from neonatal septicaemia (NNS) in low-middle income country remain high at the background of strained health care delivery system.The burden, pooled risks and outcomes of NNS are largely unknown. We aimed to produce a protocol for synthesizing evidence from available data for neonatal septicaemia in sub-Saharan Africa.Methods: We developed a search strategy using MeSH, text words and entry terms. Nine databases will be searched: PubMed, Embase, CINAHL, AJOL, Google Scholar, Web of Science, Cochrane Library, Research gate and Scopus. Only Observational studies retrievable in the English Language will be included. The primary measurable outcome is the proportion of neonatal with septicaemia while secondary outcomes include proportion of bacterial isolates and their antibiogram, risk factors for NNS, in hospital mortality, length of hospital stay, frequency of necrotizing enterocolitis and other sequel . All identified studies will be screened based on the inclusion criteria. Data will be deduplicated in Endnote version 9, before exporting to Rayyan QCRI for screening. Extractable data will include first author’s name and year of publication, the country and regions in sub-Saharan Africa, total neonatal admissions, number with sepsis, the sample size, bacterial isolates, antibiogram, in-hospital mortality, length of hospital stay and frequency of necrotizing enterocolitis.All studies will be assessed for methodological, clinical and statistical heterogeneity. The NIH Quality assessment tool for observational studies and the Cochrane tool of risk of bias will be used to assess for the strength of evidence. Publication bias will be assessed using the funnel plot.Discussion: Results will be presented as the prevalence, standard error and confidence interval of newborns with neonatal septicaemia in sub-Saharan Africa. Subgroup analysis using categorical data such as risk factors, bacterial isolates, antibiogram and outcomes of neonatal septicaemia will also be reported. A cumulative meta-analysis will be done to assess the time trend of the risk factors, pathogens and antibiogram.The CMA version 3 will be used for statistical analysis. Results will be presented in forest plots.Systematic Review Registration: This protocol is registered in PROSPERO, registration number CRD42020219604.

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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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Association of low birthweight with indoor air pollution from biomass fuel in sub-Saharan Africa: A systemic review and meta-analysis

Sustainable Environment ◽

10.1080/27658511.2021.1922185 ◽

2021 ◽

Vol 7 (1) ◽

pp. 1922185

Author(s):

Girum Gebremeskel Kanno ◽

Robel Hussen Kabthymer

Keyword(s):

Air Pollution ◽

Indoor Air ◽

Indoor Air Pollution ◽

Low Birthweight ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Biomass Fuel ◽

Systemic Review ◽

Sub Saharan

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Burden, risk factors and maternal and offspring outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa (SSA): a systematic review and meta-analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2593-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Barnabas Kahiira Natamba ◽

Arthur Araali Namara ◽

Moffat Joha Nyirenda

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Meta Analysis ◽

Previous History ◽

Sub Saharan Africa ◽

African Women ◽

History Of ◽

Sub Saharan

Abstract Background The burden, determinants and outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa are not known. We summarized existing evidence on the prevalence, risk factors and complications of GDM in the region. Methods PubMed was searched from inception to January 31st 2019. Studies were included if carried out in any of the sub-Saharan Africa countries and were available as abstracts or full texts. Interventional studies and those only including qualitative data were excluded. We employed random effects modelling to estimate the pooled GDM prevalence and risk ratios (RRs) for risk factors and outcomes of GDM and their 95%CI. Results 283 papers were identified in the initial search, 33 of which met the inclusion criteria. Data on GDM burden suggest a pooled prevalence of 9% (95%CI, 7–12%). Family history of type 2 diabetes and previous history of GDM, macrosomia, stillbirth and abortion were important risk factors of GDM. In addition, being overweight or obese, over 25 years of age or hypertensive increased the risk of GDM. In terms of complications, GDM more than doubles the risk macrosomia (RR; 95%CI: 2.2; 1.1–4.4). Conclusions There is a high burden of gestational diabetes mellitus in sub-Saharan Africa, but more studies are needed to document locally important risk factors as well as maternal and offspring outcomes. Interventions to reduce obesity among older African women might lead to reduced risk of GDM in sub-Saharan Africa.

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A Scoping Review of the Risk Factors Associated with Anaemia among Children Under Five Years in Sub-Saharan African Countries

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17238829 ◽

2020 ◽

Vol 17 (23) ◽

pp. 8829

Author(s):

Phillips Edomwonyi Obasohan ◽

Stephen J. Walters ◽

Richard Jacques ◽

Khaled Khatab

Keyword(s):

Risk Factors ◽

Scoping Review ◽

Household Wealth ◽

Sub Saharan Africa ◽

Cochrane Library ◽

Children Under Five ◽

Contextual Risk ◽

Under Five ◽

Factors Associated ◽

Sub Saharan

Background/Purpose: Globally, anaemia is a severe public health condition affecting over 24% of the world’s population. Children under five years old and pregnant women are the most vulnerable to this disease. This scoping review aimed to evaluate studies that used classical statistical regression methods on nationally representative health survey data to identify the individual socioeconomic, demographic and contextual risk factors associated with developing anaemia among children under five years of age in sub-Saharan Africa (SSA). Methods/Design: The reporting pattern followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The following databases were searched: MEDLINE, EMBASE (OVID platform), Web of Science, PUBMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Cochrane library, African Journal of online (AJOL), Google Scholar and Measure DHS. Results: The review identified 20 relevant studies and the risk factors for anaemia were classified as child-related, parental/household-related and community- or area-related factors. The risk factors for anaemia identified included age, birth order, sex, comorbidities (such as fever, diarrhoea and acute respiratory infection), malnutrition or stunting, maternal education, maternal age, mother’s anaemia status, household wealth and place of residence. Conclusion: The outcome of this review is of significant value for health policy and planners to enable them to make informed decision that will correct any imbalances in anaemia across socioeconomic, demographic and contextual characteristics, with the view of making efficient distributions of health interventions.

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Intimate Partner Violence (IPV) Against HIV-Positive Women in Sub-Saharan Africa: A Mixed-Method Systematic Review and Meta-Analysis

Trauma Violence & Abuse ◽

10.1177/1524838020906560 ◽

2020 ◽

pp. 152483802090656 ◽

Cited By ~ 2

Author(s):

Eric Y. Tenkorang ◽

Michael Asamoah-Boaheng ◽

Adobea Y. Owusu

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Intimate Partner Violence ◽

Partner Violence ◽

Meta Analysis ◽

Intimate Partner ◽

Sub Saharan Africa ◽

Hiv Positive ◽

Hiv Positive Women ◽

Sub Saharan

Objectives: To systematically analyze and summarize the literature on intimate partner violence (IPV) against HIV-positive women in sub-Saharan Africa (SSA) and to identify their risk factors for IPV. Method: A comprehensive review of the literature using the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analyses of Observational Studies in Epidemiology (MOOSE) yielded 1,879 articles (PubMed = 1,251, Embase = 491, Web of Science = 132, and identified additional records = 5). Twenty were selected for quantitative and qualitative assessment and synthesis. We employed a random effects model with generic inverse variance method and estimated the odds ratios. Findings: Results indicated a high prevalence of physical, sexual, and emotional violence against women living with HIV/AIDS in SSA. Educational background, alcohol use, marital status, previous experiences with IPV, and employment status were identified as significant risk factors. We also assessed the methodological quality of the articles by examining publication bias and some heterogeneity statistics. Conclusion: There is limited research on IPV against HIV-positive women in SSA. However, the few existing studies agree on the importance of targeting HIV-positive women with specific interventions given their vulnerability to IPV and to address factors exacerbating these risks and vulnerabilities.

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Association Between Food Insecurity and Key Metabolic Risk Factors for Diet-Sensitive Non-Communicable Diseases in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-23105/v1 ◽

2020 ◽

Author(s):

Sphamandla Josias Nkambule ◽

Indres Moodley ◽

Desmond Kuupiel ◽

Tivani P. Mashamba-Thomson

Keyword(s):

Risk Factors ◽

Food Insecurity ◽

Meta Analysis ◽

Communicable Diseases ◽

Metabolic Risk Factors ◽

Sub Saharan Africa ◽

Metabolic Risk ◽

Non Communicable Diseases ◽

Causal Pathway ◽

Sub Saharan

Abstract BackgroundIn previous studies, food insecurity has been hypothesised to promote the prevalence of metabolic risk factors on the causal pathway to diet-sensitive non-communicable diseases (NCDs). This prevalence has been shown to differ between gender and populations. However, evidence of this association in resources-limited settings with high levels of food insecurity such as sub-Saharan African countries remains elusive.PurposeWe aimed to identify the association between food insecurity and key metabolic risk factors on the causal pathway to diet-sensitive NCDs in sub-Saharan African population.MethodsWe did a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Relevant studies published between January 2015 and October 2019 were searched in PubMed, Web of Science (SCiELO Citation Index), and five other databases followed by explicit and reproducible hand-searches of included studies which were peer-reviewed epidemiological studies conducted in sub-Saharan Africa, directly measured food insecurity, and compared food insecurity to a metabolic risk factor outcome. Two reviewers extracted all the necessary data from individual studies independently and employed the Mixed Methods Appraisal Tool (MMAT) – Version 2018 to evaluate the risk of bias. Prevalence estimates from individual studies were pooled using the random-effect model.ResultsThe initial searches yielded 11 803 articles, 22 were eligible for inclusion, presenting data from 26 609 food-insecure participants and 11 545 incident of metabolic risk factor cases. Most studies confirmed an adverse association between food insecurity and key metabolic risk factors for diet-sensitive NCDs. The Meta-analysis showed a significantly high pooled prevalence estimate of key metabolic risk factors at 41.8 per cent (95% CI: 33.2% to 50.8%, I2 = 99.5% p-value < 0.00). The most prevalent type of metabolic risk factors was dyslipidaemia 27.6 per cent (95% CI: 6.5% to 54.9%), hypertension 24.7 per cent (95% CI: 15.6% to 35.1%), and overweight 15.8 per cent (95% CI: 10.6% to 21.7%). Notably, the prevalence estimates of these metabolic risk factors were considerably more frequent in females than males.ConclusionThis study is the first to systematically review or meta-analyse the association between food insecurity and key metabolic risk factors for diet-sensitive non-communicable diseases (NCDs) in sub-Saharan African countries, in order to generate an integrated, evidence-based, comprehensive summary of how key metabolic risk factors are patterned by food insecurity. Further high-quality longitudinal data and mediation analysis are warranted to understand the basis of this findings to support targeted prevention and control strategies for those confronted with food insecurity.PROSPERO registration number: PROSPERO 2019 CRD42019136638

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