scholarly journals Choice of initial antiretroviral drugs and treatment outcomes among HIV-infected patients in sub-Saharan Africa: systematic review and meta-analysis of observational studies

2017 ◽  
Vol 6 (1) ◽  
Author(s):  
Tadesse Awoke Ayele ◽  
Alemayehu Worku ◽  
Yigzaw Kebede ◽  
Kassahun Alemu ◽  
Adetayo Kasim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Outcomes ◽  
Observational Studies ◽  
Meta Analysis ◽  
Antiretroviral Drugs ◽  
Sub Saharan Africa ◽  
Sub Saharan

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

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.

scholarly journals Treatment outcomes in adult tuberculous meningitis: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Anna M Stadelman ◽  
Jayne Ellis ◽  
Thomas H A Samuels ◽  
Ernest Mutengesa ◽  
Joanna Dobbin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Outcomes ◽  
Tuberculous Meningitis ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Significant Heterogeneity ◽  
Hiv Positive Adults ◽  
Sub Saharan ◽  
Meta Analyses

Abstract Background There is substantial variation in the reported treatment outcomes for adult tuberculous meningitis (TBM). Data on survival and neurological disability by continent and HIV serostatus are scarce. Methods We performed a systematic review and meta-analysis to characterize treatment outcomes for adult TBM. Following a systematic literature search (MEDLINE and EMBASE), studies underwent duplicate screening by independent reviewers in two stages to assess eligibility for inclusion. Two independent reviewers extracted data from included studies. We employed a random effects model for all meta-analyses. We evaluated heterogeneity by the I2 statistic. Results We assessed 2,197 records for eligibility; 39 primary research articles met our inclusion criteria reporting on treatment outcomes for 5,752 adults with TBM. The commonest reported outcome measure was six-month mortality. Pooled six-month mortality was 24% and showed significant heterogeneity (I2 >95%; p<0·01). Mortality ranged from 2% to 67% in Asian studies and from 23% to 80% in sub-Saharan African studies. Mortality was significantly worse in HIV-positive adults at 57% (95%CI; 48-67%), compared with 16% (95%CI; 10-24%) in HIV-negative adults (p<0·01). Physical disability was reported in 32% (95%CI; 22-43%) of adult TBM survivors. There was considerable heterogeneity between studies in all meta-analyses with I2 statistics consistently >50%. Conclusions Mortality in adult TBM is high and varies considerably by continent and HIV-status. The highest mortality is amongst HIV-positive adults in sub-Saharan Africa. Standardized reporting of treatment outcomes will be essential to improve future data quality and increase potential for data sharing, meta-analyses, and facilitating multi-center tuberculosis research to improve outcomes.

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

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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