Validation of Pediatric Self-Report Pain Scales in Sub-Saharan Africa: A Systematic Review

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Pediatric self-report pain scales must be validated in cultural/language contexts to provide optimal pain management. Sub-Saharan Africa included vast numbers of people groups, cultures, and languages. This systematic review sought to identify studies that validated a self-report pediatric pain scale within a sub-Saharan African context. We searched CINAHL, EMBASE, and PubMed combining four concepts: children, pain, sub-Saharan Africa, and scales. Two independent reviewers screened abstracts for the inclusion criteria: English, prospective studies, a pediatric population, and conducted in sub-Saharan Africa. Full text of qualifying citations was obtained. Of 1591 citations identified, six were included. Self-report pain scales included the Faces Pain Scale - Revised (FPS-R), Faces Pain Scale, McGill Questionnaire, Numerical Rating Scale (NRS), Oucher Pain Scale and Visual Analog Scale (VAS). Validation characteristics varied from construct validity (two studies) to convergent validity (three studies) and discriminant validity (three studies). Methods included qualitative and quantitative approaches. Pearson/Spearman's correlation coefficients were strongest between self-report pain scales and weakest when compared to observational scales. The interview-based studies also assessed decision making process, comprehension, ease of use, pain perception, gender, and societal roles. Languages included were English, Afrikaans, Xhosa, Amharic, Swahili, Grammar English, Cameroonian Pidgin English and French. 5 countries in Sub-Saharan Africa have a self-report pediatric pain scale validated in their national language/context. Validation methods varied widely from qualitative to quantitative, including convergent, discriminant and face validity. Given the burden of pediatric pain in sub-Saharan Africa, further work is required to provide culturally appropriate and language-specific pain tools.