Conditions In sub-Saharan Africa Research Articles

Sustainable development goals: Attaining sustainable living through financial inclusion in Sub-Saharan Africa

This study examines the effect of financial inclusion on sustainable living in 20 sub-Saharan African countries using the panel Autoregressive Distributive Lag (ARDL) model. The findings indicate that FII, the numbers of borrowers, depositors, bank branches and automated teller machines exert a significant effect on GDP per capita in sub-Saharan Africa. The Pooled Mean Group (PMG) estimates further indicate that FII (which captured the combined effect of financial access and usage) exerts a negative effect on gross domestic product (GDP) per capita in sub-Saharan Africa (SSA). However, the results of the individual measures of financial inclusion, that is, the numbers of borrowers, depositors and banking penetration exert a positive effect on gross domestic product (GDP) per capita in the long run in sub-Saharan Africa. This portends that financial inclusion is a significant contributor that can improve sustainable living conditions in sub-Saharan Africa. Based on these, the study recommends the need to improve access to and usage of financial products and services through user-friendly and service-fluent financial technologies in sub-Saharan Africa. This will help increase the number of households, smallholder farmers and businesses to access the formal financial system to meet their reoccurring and precautionary funding needs in sub-Saharan African countries.

Characteristics and outcomes of patients with symptomatic chronic myocardial injury in a Tanzanian emergency department: A prospective observational study.

Chronic myocardial injury is a condition defined by stably elevated cardiac biomarkers without acute myocardial ischemia. Although studies from high-income countries have reported that chronic myocardial injury predicts adverse prognosis, there are no published data about the condition in sub-Saharan Africa. Between November 2020 and January 2023, adult patients with chest pain or shortness of breath were recruited from an emergency department in Moshi, Tanzania. Medical history and point-of-care troponin T (cTnT) assays were obtained from participants; those whose initial and three-hour repeat cTnT values were abnormally elevated but within 11% of each other were defined as having chronic myocardial injury. Mortality was assessed thirty days following enrollment. Of 568 enrolled participants, 81 (14.3%) had chronic myocardial injury, 73 (12.9%) had acute myocardial injury, and 412 (72.5%) had undetectable cTnT values. Of participants with chronic myocardial injury, the mean (± sd) age was 61.5 (± 17.2) years, and the most common comorbidities were CKD (n = 65, 80%) and hypertension (n = 60, 74%). After adjusting for CKD, thirty-day mortality rates (38% vs. 36%, aOR 1.03, 95% CI: 0.52-2.03, p = 0.931) were similar between participants with chronic myocardial injury and those with acute myocardial injury, but significantly greater (38% vs. 13.6%, aOR 3.63, 95% CI: 1.98-6.65, p<0.001) among participants with chronic myocardial injury than those with undetectable cTnT values. In Tanzania, chronic myocardial injury is a poor prognostic indicator associated with high risk of short-term mortality. Clinicians practicing in this region should triage patients with stably elevated cTn levels in light of their increased risk.

P3: The care of older people with depression in Nigeria: experience in primary care settings.

Background:There is a large treatment gap for mental health conditions in sub-Saharan Africa where most of affected persons who receive any care do so from non-physician primary health care workers (PHCW). We examined the experience of PHCW who provide care for older people with depression in Nigerian primary health care (PHC) settings.Methods:Using in-depth key informant interviews, we explored the views of 15 PHCWs, 11 of whom were community health workers (CHWs) and 4 were community health extension workers (CHEWs), selected from 10 rural and urban PHCs in South-Western Nigeria. Two additional focus group discussions, each comprising eight participants drawn from across different cadres of PHCW (N=16), were also conducted. Thematic analysis was carried out using a three-staged constant comparison technique to refine and categorise the data.Results:Four overall themes were identified around PHCWs’ experience of caring for older people with depression who presented to PHCs: depression presentation, treatment options, community outreach, and value of mobile technology. Participants identified depression in older people as being characterized by a range of behavioural, cognitive, sleep and bodily symptoms, which were often triggered by economic challenges and poor social support. Common treatment options used by PHCW included general advice and counselling, as well as vitamins and occasional sedatives. Although community outreach and follow-ups are parts of their expected work schedule, PHCW rarely implement these due to non-availability of transport facilities. Mobile technology was identified as a possible way of overcoming this constraint to providing community based mental healthcare for older people.Conclusion:Our findings suggest that mobile technology could be a viable way to expand the quality of service provided to older persons with depression by including community outreach and follow-up.

Use of hospital services by patients with chronic conditions in sub-Saharan Africa: a systematic review and meta-analysis.

To estimate the prevalence of individual chronic conditions and multimorbidity among adults admitted to hospital in countries in sub-Saharan Africa. We systematically searched MEDLINE®, Embase®, Global Index Medicus, Global Health and SciELO for publications reporting on patient cohorts recruited between 1 January 2010 and 12 May 2023. We included articles reporting prevalence of pre-specified chronic diseases within unselected acute care services (emergency departments or medical inpatient settings). No language restrictions were applied. We generated prevalence estimates using random-effects meta-analysis alongside 95% confidence intervals, 95% prediction intervals and I2 statistics for heterogeneity. To explore associations with age, sex, country-level income status, geographical region and risk of bias, we conducted pre-specified meta-regression, sub-group and sensitivity analyses. Of 6976 identified studies, 61 met the inclusion criteria, comprising data from 20 countries and 376 676 people. None directly reported multimorbidity, but instead reported prevalence for individual conditions. Among medical admissions, the highest prevalence was human immunodeficiency virus infection (36.4%; 95% CI: 31.3-41.8); hypertension (24.4%; 95% CI: 16.7-34.2); diabetes (11.9%; 95% CI: 9.9-14.3); heart failure (8.2%; 95% CI: 5.6-11.9); chronic kidney disease (7.7%; 95% CI: 3.9-14.7); and stroke (6.8%; 95% CI: 4.7-9.6). Among patients seeking hospital care in sub-Saharan Africa, multimorbidity remains poorly described despite high burdens of individual chronic diseases. Prospective public health studies of multimorbidity burden are needed to generate integrated and context-specific health system interventions that act to maximize patient survival and well-being.

Deriving Surface Water Storage and Curve Numbers from Rainfall–Runoff Relationships in Conventional and Minimum Tillage Systems in Gwanda, Zimbabwe

Soil water availability is one of the major constraints limiting crop productivity under semi-arid conditions in sub-Saharan Africa. Crop models are tools that can be used to explain and predict the effect of improved technologies on runoff and soil water availability, and their impact on crop productivity. The study hypothesized that minimum tillage treatments (planting basins and ripper) retain more rainwater and reduce runoff generation compared to conventional tillage treatments in maize-based cropping systems. Runoff plots were established on-farm and surface runoff was collected after each daily rainfall event. Surface water storage and curve number for each conventional and minimum tillage treatment were derived from the runoff and rainfall amounts measured over two growing seasons. Daily rainfall events of 9–76 mm generated runoff in both conventional and minimum tillage treatments. Planting basins retained more rainwater (12–19%) and reduced runoff generation (40–51%) than the conventional and ripper tillage treatments. Runoff generation in the tillage treatments varied with soil texture. Conventional and double ploughing treatments recorded more runoff (11–12%) in loamy sands than in sandy soil. Surface water storage and curve numbers from tillage treatments were consistent with runoff results and with conventional treatments, having higher curve numbers than minimum tillage practices. Conventional and ripper tillage practices have similar runoff potential as demonstrated by their curve numbers generated in this study. Curve numbers of 75–76 for conventional and 72–74 for minimum tillage systems are practical under light-textured soil and a land slope of &lt;2% when conventional and minimum tillage practices are implemented.

Cognitive Dysfunction in Patient with Chronic Medical Condition in Sub-Saharan Africa

Cognitive Dysfunction in Patient with Chronic Medical Condition in Sub-Saharan Africa

Anaemia in subsaharan Africa: A review of causes, risk factors, diagnostic challenges and evident based management

Anemia is a serious health condition in Sub Saharan Africa (SSA). The region is vulnerable to multiple underlying causes of anaemia that are many and varied. It affects children under five years, nonpregnant women, pregnant women and the elderly. Many interventions that include nutritional food fortification and infection control programmm through malaria infection control and many other infection control programs were designed in order to reduce the prevalency of anemia in SSAcountries but low success was acheived due to so many varied factors. So in this review we discussed on the major causes of anemia, risk factors, diagnostic challenges and management of anemia in SSA.countries. The methodology used was to review previous literatures on the subjects.

Potential cost and benefits of integrating health care services for managing multiple chronic conditions in sub-Saharan Africa: A critical short review and commentary

Sub-Saharan Africa is currently having a dual burden of HIV and Non-communicable diseases. HIV is regarded as a chronic condition regardless of HIV being infectious, due to the absence of a cure. However, these patients have achieved a substantial increase in survival after receiving Antiretroviral Therapy (ART). An increase in survival puts HIV patients at risk of developing Non-Communicable Diseases (NCD). Integration of health services for chronic diseases has been one of the suggested measures to be considered and recently, a scientist has invested to conduct research in this area to see if it can help to improve the quality of health care services particularly in resource-limited countries. Most of the published work has found that; the integration of health services for chronic diseases into a single clinic is potentially cost-effective and has benefits. This approach could be used to minimize cost and help improve the quality of life and increase life expectancy among HIV-infected individuals. However, these findings need further evidence because some of the published data were obtained from weak study designs, and those regarded as strong were designed as pilots.

Sleep Apnea Syndrome: Prevalence and Comorbidity with Other Non-communicable Diseases and HIV Infection, among Hospitalized Patients in Yaoundé, Cameroon.

Background Sleep apnea syndrome (SAS), a growing public health threat, is an emerging condition in sub-Saharan Africa (SSA). Related SSA studies have so far used an incomplete definition. This study is aimed at assessing SAS using an American Academy of Sleep Medicine (AASM) complete definition and at exploring its relationship with comorbidities, among patients hospitalized in a Cameroonian tertiary hospital. Methods This cross-sectional study was conducted in cardiology, endocrinology, and neurology departments of the Yaoundé Central Hospital. Patients aged 21 and above were consecutively invited, and some of them were randomly selected to undergo a full night record using a portable sleep monitoring device, to diagnose sleep-disordered breathing (SDB). SAS was defined as an apnea − hypopnea index (AHI) ≥ 5/h, associated with either excessive daytime sleepiness or at least 3 compatible symptoms. Moderate to severe SAS (MS-SAS) stood for an AHI ≥ 15/h. We used chi-square or Fisher tests to compare SAS and non-SAS groups. Findings. One hundred and eleven patients presented a valid sleep monitoring report. Their mean age ± standard deviation (range) was 58 ± 12.5 (28–87) years, and 53.2% were female. The prevalence (95% confident interval (CI)) of SAS was 55.0 (45.7, 64.2)% and the one of MS-SAS 34.2 (25.4, 43.1)%. The obstructive pattern (90.2% of SAS and 86.8% of MS-SAS) was predominant. The prevalence of SAS among specific comorbidities ranged from 52.2% to 75.0%. Compared to SAS free patients, more SAS patients presented with hypertension (75.4% vs. 48.0%, p = 0.005%), history of stroke (36.7% vs. 32.0%, p = 0.756), cardiac failure (23.0% vs. 12.0%, p = 0.213), and combined cardiovascular comorbidity (80.3% vs. 52.0%, p = 0.003). Similar results were observed for MS-SAS. Metabolic and neuropsychiatric comorbidities did not differ between SAS and SAS-free patients. Conclusion The SAS diagnosed using modified AASM definition showed high prevalence among patients hospitalized for acute medical conditions, as it was found with SDB. Unlike HIV infection, metabolic and brain conditions, cardiovascular comorbidities (hypertension and cardiac failure) were significantly more prevalent in SAS patients.

Xeroderma pigmentosa: a report of three paediatric cases in Eastern Zambia, and review of the literature of this rare condition amongst sub-Saharan Africans (case report)

The diagnosis and management of xeroderma pigmentosa (XP) remains a challenge in sub-Saharan Africa due to limited health care access, lack of specialist care and weak diagnostic testing. The purpose of this paper is to highlight the importance of clinical approach in the diagnosis of XP in a low resource setting and to discuss some of the challenges these patients face living with XP. Three cases of children who presented with signs and symptoms of XP are discussed; their case histories are notable for demonstrating some of the challenges of managing the condition in sub-Saharan Africa. Management of XP is particularly complicated by the fact that there is no known cure for the condition and the need for complete shielding from ultraviolet (UV) light in a region with warm weather and abundant sunshine. A previously unreported effect of XP on the patients and their families is stigma and social exclusion. Setting up of, and linking the clients to psychosocial support groups would be of great benefit in alleviating the psychological effects of the disease.

Selective laser trabeculoplasty versus 0·5% timolol eye drops in the management of glaucoma in Tanzania

Africa has the highest prevalence of glaucoma blindness worldwide.1 Factors such as insufficient awareness and knowledge about the disease, poverty of resources, competing individual needs, scarce access to affordable treatment, low ophthalmologist to population ratio, ineffective government policies, and collapse of primary health-care services in many countries2 all contribute to the burden of this condition in sub-Saharan Africa.

Intimate Partner Violence against Women Living in Inadequate Conditions in Sub-Saharan Africa: A Meta-Analysis of Demographic and Health Survey Data.

Intimate partner violence (IPV) against women is a major public health problem and is widespread in sub-Saharan Africa (SSA). However, little is known about its environmental determinants. This study aimed to investigate whether inadequate living conditions are associated with IPV victimization in women in SSA. We analyzed cross-sectional data for 102,714 women in 25 SSA countries obtained from the Demographic and Health Surveys Program. Logistic regression was used to estimate the country-specific effects of inadequate living conditions (housing with at least one of four characteristics of unimproved water, unimproved sanitation, insufficient space, and unfinished materials) on multiple forms of IPV. Random effects meta-analysis was used to combined the country-specific estimates. We found an association between inadequate living conditions and a higher likelihood of experiencing any (OR = 1.12, 95% CI 1.03 to 1.23, p = 0.012), sexual (OR = 1.18, 95% CI 1.05 to 1.34, p = 0.008), emotional (OR = 1.12, 95% CI 1.02 to 1.23, p = 0.023), and physical (OR = 1.15, 95% CI 1.03 to 1.28, p = 0.010) IPV. The associations were stronger for rural and less-educated women. These findings suggest that future research to establish a causal link between living conditions and IPV and to elucidate the underlying pathways is crucial to design IPV interventions in SSA.

Patient and health provider costs of integrated HIV, diabetes and hypertension ambulatory health services in low-income settings \u2014 an empirical socio-economic cohort study in Tanzania and Uganda

BackgroundIntegration of health services might be an efficient strategy for managing multiple chronic conditions in sub-Saharan Africa, considering the scope of treatments and synergies in service delivery. Proven to promote compliance, integration may lead to increased economies-of-scale. However, evidence on the socio-economic consequences of integration for providers and patients is lacking.We assessed the clinical resource use, staff time, relative service efficiency and overall societal costs associated with integrating HIV, diabetes and hypertension services in single one-stop clinics where persons with one or more of these conditions were managed.Methods2273 participants living with HIV infection, diabetes, or hypertension or combinations of these conditions were enrolled in 10 primary health facilities in Tanzania and Uganda and followed-up for up to 12 months. We collected data on resources used from all participants and on out-of-pocket costs in a sub-sample of 1531 participants, while a facility-level costing study was conducted at each facility. Health worker time per participant was assessed in a time-motion morbidity-stratified study among 228 participants. The mean health service cost per month and out-of-pocket costs per participant visit were calculated in 2020 US$ prices. Nested bootstrapping from these samples accounted for uncertainties. A data envelopment approach was used to benchmark the efficiency of the integrated services. Last, we estimated the budgetary consequences of integration, based on prevalence-based projections until 2025, for both country populations.ResultsTheir average retention after 1 year service follow-up was 1911/2273 (84.1%). Five hundred and eighty-two of 2273 (25.6%) participants had two or all three chronic conditions and 1691/2273 (74.4%) had a single condition. During the study, 84/2239 (3.8%) participants acquired a second or third condition. The mean service costs per month of managing two conditions in a single participant were $39.11 (95% CI 33.99, 44.33), $32.18 (95% CI 30.35, 34.07) and $22.65 (95% CI 21.86, 23.43) for the combinations of HIV and diabetes and of HIV and hypertension, diabetes and hypertension, respectively. These costs were 34.4% (95% CI 17.9%, 41.9%) lower as compared to managing any two conditions separately in two different participants. The cost of managing an individual with all three conditions was 48.8% (95% CI 42.1%, 55.3%) lower as compared to managing these conditions separately.Out-of-pocket healthcare expenditure per participant per visit was $7.33 (95% CI 3.70, 15.86). This constituted 23.4% (95% CI 9.9, 54.3) of the total monthly service expenditure per patient and 11.7% (95% CI 7.3, 22.1) of their individual total household income. The integrated clinics’ mean efficiency benchmark score was 0.86 (range 0.30–1.00) suggesting undercapacity that could serve more participants without compromising quality of care. The estimated budgetary consequences of managing multi-morbidity in these types of integrated clinics is likely to increase by 21.5% (range 19.2–23.4%) in the next 5 years, including substantial savings of 21.6% on the provision of integrated care for vulnerable patients with multi-morbidities.ConclusionIntegration of HIV services with diabetes and hypertension control reduces both health service and household costs, substantially. It is likely an efficient and equitable way to address the increasing burden of financially vulnerable households among Africa’s ageing populations.Additional economic evidence is needed from longer-term larger-scale implementation studies to compare extended integrated care packages directly simultaneously with evidence on sustained clinical outcomes.

Effect of health outcome on economic growth in sub-Saharan Africa: a system generalized method of moment approach

PurposeSome progress have been made over time in improving health conditions in Sub-Saharan Africa (SSA). There are, however, contradicting reports on the relationship between health outcomes and economic growth in the region. The paper aimed at assessing the effect of health outcome on economic growth in SSA.Design/methodology/approachData for 41 countries from 2000 to 2018 were obtained from WDI and WGI and analyzed using system generalized method of moment (sGMM) which is appropriate for the present scenario. AR(1) and AR(2) tests were used to assess the validity of the model while Sargan and Hansen tests were adopted to examine the validity of the instrumental variables. The robustness of the estimation was confirmed using the pooled OLS and fixed effect regression.FindingsHealth outcome (proxied by life expectancy), lagged GDP per capita, capital formation, labor force (LF), health expenditure (HE), foreign direct investment (FDI) and trade openness (TOP) significantly affected economic growth emphasizing the importance of health in the process of economic growth in the region. AR(1) and AR(2) tests for serial correlation and Sargan/Hansen tests confirmed the validity of the estimated model and the instrumental variables respectively. Robustness of the GMM results was established from the pooled OLS and the fixed effect model results.Social implicationsImprovement in the national health system possibly through the widespread adoption of National Health Insurance, increase government spending on healthcare alongside increased beneficial trade and ease of doing business to facilitate investment were recommended to enhance.Originality/valueThe study used up-to-date data with appropriate methodology.

Immediate impacts of COVID-19 measures on bean production, distribution, and food security in Eastern Africa

The outbreak of coronavirus was expected to adversely affect African countries more than any other region in the world. This assertion was based on the existing conditions in sub-Saharan Africa that exposed the region to the dire consequences of the pandemic. Previously existing underlying conditions that affected the food system include a high dependence on trade for inputs supply, the adverse effects of climate change, crop pests and diseases, poverty, low input use, weak institutions and ineffective poli¬cies, and insecurity and conflicts. We collected data from farmers, aggregators, bean research coordina¬tors, and urban and peri-urban consumers in five Eastern African countries in order to describe the immediate impacts of the pandemic on the bean value chain. Access to seed and labor appear to be the most critical impacts of the pandemic on bean production. There are observable differences in patterns and frequency of bean consumption in these regions, suggesting that the effect of the pandemic depends on the level of implementation of containment measures and pre–COVID-19 underlying conditions that affect the food systems. In the mid to long-term, the pandemic may disrupt food systems, resulting in hunger, malnutrition, and food insecurity. Thus, governments should support farmers and businesses in becoming resilient to exogenous shocks through increased efficiency in supply chains, capacity building, and the adoption of modern digital technology.

Preoperative anemia and surgical outcomes following laparotomy in a resource-limited setting

IntroductionAnemia is a common and potentially modifiable condition in sub-Saharan Africa. We sought to determine the role of preoperative anemia on post laparotomy abdominal complications. MethodsWe conducted a six-month prospective, observational study of patients age >12 years following laparotomy at a tertiary hospital in Malawi. The outcome was the occurrence of abdominal complications. Poisson regression analyses estimated the risk of abdominal complications in patients with moderate/severe anemia. ResultsOf 280 patients, most were male (76.4%) with median age of 35 years (IQR 24–50). Abdominal complications developed in 34 patients (15.2%). Of the 224 patients with known preoperative hemoglobin 54 (20.7%) were moderately or severely anemic at the time of surgery. Patients with moderate-to-severe anemia had an increased risk of abdominal complications (RR 4.44, 95% CI 2.0–9.6). ConclusionAnemia is a common but modifiable comorbidity among laparotomy patients and independently increases the risk of abdominal complications.

Tapping the potential of grafting to improve the performance of vegetable cropping systems in sub-Saharan Africa. A review

Vegetable grafting is developing worldwide to cope with biotic and abiotic stresses. This technique faces strong regional disparities and its potential to improve crop performances is currently underexploited in sub-Saharan Africa. This review explores the potential of grafting to increase and secure vegetable production in challenging production conditions in sub-Saharan Africa and to identify the obstacles to its adoption. The major conclusions that can be drawn from the review are (1) the capacity of vegetable grafting to overcome several agronomic challenges commonly encountered in sub-Saharan Africa particularly for soilborne diseases; (2) grafting does not systematically lead to higher yields since the performance of grafted plants is closely linked with the combination of scion–rootstock chosen; (3) resistant rootstocks to the local soilborne pathogens could be identified through short-term laboratory and field experiments whereas the improvement of the tolerance to abiotic stresses would require deeper knowledge on underlying mechanisms; (4) the significant increase in the cost of using grafted plants are warranted in systems where there are no other technical alternatives to manage biotic and abiotic stresses, where profitability per plant is high, or where the use of grafted plants makes it possible to reach a profitable niche market such as off-season or organic products; and (5) vegetable grafting should therefore be promoted by providing evidence for its profitability in different production systems (open field and greenhouse cultivation) combined with supply-side interventions to build or strengthen the capacity of nursery operators to provide a continuous supply of good-quality grafted plants.

A Review of the Impact of Mycotoxins on Dairy Cattle Health: Challenges for Food Safety and Dairy Production in Sub-Saharan Africa.

Mycotoxins are secondary metabolites of fungi that contaminate food and feed and have a significant negative impact on human and animal health and productivity. The tropical condition in Sub-Saharan Africa (SSA) together with poor storage of feed promotes fungal growth and subsequent mycotoxin production. Aflatoxins (AF) produced by Aspergillus species, fumonisins (FUM), zearalenone (ZEN), T-2 toxin (T-2), and deoxynivalenol (DON) produced by Fusarium species, and ochratoxin A (OTA) produced by Penicillium and Aspergillus species are well-known mycotoxins of agricultural importance. Consumption of feed contaminated with these toxins may cause mycotoxicoses in animals, characterized by a range of clinical signs depending on the toxin, and losses in the animal industry. In SSA, contamination of dairy feed with mycotoxins has been frequently reported, which poses a serious constraint to animal health and productivity, and is also a hazard to human health since some mycotoxins and their metabolites are excreted in milk, especially aflatoxin M1. This review describes the major mycotoxins, their occurrence, and impact in dairy cattle diets in SSA highlighting the problems related to animal health, productivity, and food safety and the up-to-date post-harvest mitigation strategies for the prevention and reduction of contamination of dairy feed.

Relationship between chronic diseases and sleep duration among older adults in Ghana.

Aging increases the prevalence of health problems that are often chronic, resulting in more sleep problems for people with poor health or chronic conditions. Relatively fewer studies have been conducted on the relationship between sleep duration and chronic conditions in Sub-Saharan Africa compared to Western or Asian populations. This study uses a nationally representative sample of older adults in Ghana to examine the association between sleep duration and chronic conditions. Data were gathered from the World Health Organization Study on Global AGEing and Adult Health (SAGE) Wave 1 in Ghana (n = 3617). Data on duration of sleep and chronic conditions were derived from self-reported data and validated symptom reporting. Multinomial logistic regression was conducted to examine the association between sleep duration and chronic conditions. Women had a significantly longer period of sleep than men. Older people (> 60years) were more likely than people under 60years old to sleep for longer periods. The prevalence of stroke, depression, and chronic lung disease among long sleepers was high compared with short and medium sleepers. Our study found that respondents with stroke, arthritis, depression, chronic lung disease, asthma, and hypertension were likely to sleep for a long time. This study showed a significant association between long hours of sleep and chronic conditions. To health professionals, paying particular attention to this association among older adults is medically important.

Uncontrolled hypertension among patients with comorbidities in sub-Saharan Africa: protocol for a systematic review and meta-analysis

BackgroundUncontrolled hypertension is the most important risk factor and leading cause of cardiovascular diseases. It is predicted that the number of people with hypertension will increase, and a large proportion of this increase will occur in developing countries. The highest prevalence of uncontrolled hypertension is reported in sub-Saharan Africa, and treatment for hypertension is unacceptably low. Hypertension commonly co-exists with comorbidities and this is associated with poorer health outcomes for patients. This review aims to estimate the prevalence of uncontrolled hypertension among patients with comorbidities in sub-Saharan Africa.Methods and analysisAll published and unpublished studies on the prevalence of uncontrolled hypertension among patients with comorbidities in sub-Saharan Africa will be included. MEDLINE via OVID, Embase, and Web of Science will be searched to identify all relevant articles published from January 2000 to June 2019. Experts in the field will be contacted for unpublished literature, and Open SIGLE will be reviewed for relevant information. No language restriction will be imposed. Two reviewers will select, screen, extract data, and assess the risk of bias while a third reviewer will arbitrate the disagreements. A meta-analysis will be performed on variables that are similar across the included studies. Proportions will be stabilized before estimates are pooled using a random effects model. The presence of publication bias will be assessed using Egger’s test and visual inspection of the funnel plots. This systematic and meta-analysis review protocol will be reported in accordance with the PRISMA-P protocol guidelines. Results will be stratified by country, comorbidity, and geographic region.DiscussionThis systematic review and meta-analysis is expected to quantify the magnitude of uncontrolled hypertension among patients with certain comorbid conditions in sub-Saharan Africa to guide policies and interventions. This review is registered in PROSPERO International Prospective Register of Systematic reviews CRD42019108218.