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Adal O, Kebede N, Delie AM, Bogale EK, Anagaw TF, Tiruneh MG, Fenta ET, Endeshaw D. Hypertensive crisis and its predictors in Africa: Systematic review and meta-analysis, 2024. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200285. [PMID: 38828464 PMCID: PMC11141447 DOI: 10.1016/j.ijcrp.2024.200285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 06/05/2024]
Abstract
Introduction Hypertensive crises are a leading cause of visits to emergency departments, carrying grave health implications. A significant number of patients presenting with these crises have a known history of hypertension. Objective The aim of this systematic review and meta-analysis is to examine the combined prevalence of hypertensive crises among individuals with either a history of hypertension or unknown status (newly diagnosed with a hypertensive crisis). Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the Prospective Register of Systematic Reviews (PROSPERO). Research databases, including PubMed, Embase, Scopus, Africa Index Medicus, Science Direct, HINARI, and Google Scholar, were systematically searched. Study quality was evaluated using the Newcastle-Ottawa Scale, while publication bias was explored through Egger's regression test, funnel plots, and sensitivity analyses. Data collection adhered to the Joanna Briggs Institute (JBI) format. Meta-analysis was performed using STATA version 17, employing the random-effects DerSimonian-Laird model. Results Amongst the 15 studies analyzed, the application of the random-effects DerSimonian-Laird statistical model indicated that the prevalence of hypertensive crisis was determined to be 9.09 %, with a 95 % confidence interval (CI) ranging from 7.41 % to 10.77 %. Factors such as poor medication adherence (POR 5.00; 95 % CI: 3.61, 6.93), patients with comorbidities (POR 4.73; 95 % CI: 3.29, 6.80), patients with a history of hypertension (POR 5.64; 95 % CI: 4.57, 6.94), patients aged >65 (POR 2.77; 95 % CI: 2.16, 6.59), and excessive alcohol intake (POR 5.01; 95 % CI: 3.82, 6.58) were associated with higher odds of hypertensive crisis. Conclusion The findings indicate a markedly higher incidence of hypertensive crisis among hospital-presenting patients in Africa. Factors such as medication non-adherence, co-existing comorbidities, historical hypertension, being over 65, and alcohol misuse significantly contribute to this condition. These insights call for a comprehensive healthcare strategy that targets both the management of hypertension and its complications, aiming to improve the overall health outcomes of affected patients.
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Affiliation(s)
- Ousman Adal
- Department of Emergency and Critical Care Nursing Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar City, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health College of Medicine Health Sciences, Wollo University, Dessie City, MSc, Ethiopia
| | - Amare Mebrat Delie
- Department of Public Health, College of Medicine and Health Science, Injibara University, Injibara City, MSc, Ethiopia
| | - Eyob Ketema Bogale
- Health Promotion and Behavioral Science Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar City, MSc, Ethiopia
| | - Tadele Fentabil Anagaw
- Health Promotion and Behavioral Science Department, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar City, MSc, Ethiopia
| | - Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar City, MSc, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Science, Injibara University, Injibara City, MSc, Ethiopia
| | - Destaw Endeshaw
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar City, MSc, Ethiopia
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Schantz C, Coulibaly A, Traoré A, Traoré BA, Faye K, Robin J, Teixeira L, Ridde V. Access to oncology care in Mali: a qualitative study on breast cancer. BMC Cancer 2024; 24:81. [PMID: 38225594 PMCID: PMC10788985 DOI: 10.1186/s12885-024-11825-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in terms of incidence and mortality among women worldwide, including in Africa, and a rapid increase in the number of new cases of breast cancer has recently been observed in sub-Saharan Africa. Oncology is a relatively new discipline in many West African countries, particularly Mali; thus, little is known about the current state of cancer care infrastructure and oncology practices in these countries. METHODS To describe the challenges related to access to oncology care in Mali, we used a qualitative approach, following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Thirty-eight semistructured interviews were conducted with health professionals treating cancer in Mali (n = 10), women with breast cancer (n = 25), and representatives of associations (n = 3), and 40 participant observations were conducted in an oncology unit in Bamako. We used the theoretical framework on access to health care developed by Levesque et al. a posteriori to organise and analyse the data collected. RESULTS Access to oncology care is partly limited by the current state of Mali's health infrastructure (technical platform failures, repeated strikes in university hospitals, incomplete free health care and the unavailability of medicines) and exacerbated by the security crisis that has been occurring the country since 2012. The lack of specialist doctors, combined with limited screening campaigns and a centralised and fragmented technical platform in Bamako, is particularly detrimental to breast cancer treatment. Women's lack of awareness, lack of information throughout the treatment process, stereotypes and opposition to amputations all play a significant role in their ability to seek and access quality care, leading some women to therapeutically wander and others to want to leave Mali. It also leaves them in debt and jeopardises the future of their children. However, the high level of trust in doctors, the involvement of international actors, the level of social support and the growing influence of civil society on the issue of cancer also represent great current opportunities to fight cancer in Mali. CONCLUSION Despite the efforts of successive Malian governments and the commitment of international actors, the provision of health care is still limited in the country, entrenching global inequalities in women's bodies.
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Affiliation(s)
- Clémence Schantz
- Université Paris Cité, IRD, Inserm, Ceped, F-75 006, Paris, France.
- Institution Convergences Et Migrations, Aubervilliers, France.
| | | | | | - Bakary Abou Traoré
- Centre de Santé de Référence de La Commune 2, Bamako, Mali
- Centre National de La Recherche Scientifique Et Technologie (CNRST), Bamako, Mali
| | - Kadiatou Faye
- Association Les Combattantes du Cancer, Bamako, Mali
| | - Julie Robin
- Université Paris Cité, IRD, Inserm, Ceped, F-75 006, Paris, France
| | - Luis Teixeira
- Pathophysiology of Breast Cancer Team, Department of Senology, Université Paris Cité INSERM U976, HIPIAP-HP, Hôpital Saint-Louis, Paris, France
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75 006, Paris, France
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Magboh VO, Saba OA, Krause R, Forget P. Barriers to optimal management of cancer pain in sub-Saharan Africa: a scoping review. Ecancermedicalscience 2023; 17:1650. [PMID: 38414965 PMCID: PMC10898898 DOI: 10.3332/ecancer.2023.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Indexed: 02/29/2024] Open
Abstract
Background Although cancer is a significant issue in sub-Saharan Africa, and cancer pain is prevalent, there is insufficient data and research on the barriers to cancer pain management. Even in countries where evidence exists, few studies explore the links between these barriers, which makes it difficult to implement system-wide approaches to address them. Methods The search strategy was developed and conducted on databases including MEDLINE, Embase and Web of Science to identify peer-reviewed studies. Then, these retrieved studies were screened systematically to select papers that had met pre-specified criteria. The barriers were categorised into patient-, health professional- and health system-level domains. Then, the quality of the included papers was assessed using the mixed methods appraisal tool. Finally, a narrative synthesis was utilised to summarise the findings. Results Fourteen relevant articles from 19 sub-Saharan African countries were included in the scoping review. All the studies highlighted barriers to optimal cancer pain management. Healthcare system-related domains had the most frequently reported barriers. Approximately half of the included studies met 100% of the methodological quality criteria in the critical appraisal. Conclusion Improving pain management for cancer patients in sub-Saharan Africa requires further high-level research evidence on regulatory policies and interventional strategies, especially at the health system level, as most barriers to cancer pain treatment essentially stem from the healthcare system.
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Affiliation(s)
- Vivian Onyinyechukwu Magboh
- School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, AB24 3FX Aberdeen, UK
| | | | - Rene Krause
- Division of Interdisciplinary Palliative Care and Medicine, Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Observatory 7925, South Africa
| | - Patrice Forget
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, AB25 2ZD Aberdeen, UK
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Hendricks M, Cois A, Geel J, van Heerden J, Dandara C, Mohamed K, Donald KA, Kruger M. Socioeconomic status significantly impacts childhood cancer survival in South Africa. Pediatr Blood Cancer 2023; 70:e30669. [PMID: 37705154 DOI: 10.1002/pbc.30669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND AND AIMS Significantly discrepant survival rates have been documented in single disease childhood cancer cohorts in South Africa; those from higher socioeconomic groups were shown to have a significantly lower risk of death than those from less affluent households. This study aimed to determine the impact of socioeconomic status (SES) on childhood cancer survival using pooled South African data. METHODS Five databases spanning January 2000 to December 2021 were interrogated. SES status was assigned based on a public sector annual household income classification. H0 households (formally unemployed) received free healthcare. H1, H2 and H3 (annual income > United States Dollar [USD] 19,000) households paid for healthcare relative to their income. The Spearman test assessed correlations between SES and disease stage in patients with solid tumours. Hazard ratios were determined using Cox regression modelling. The Kaplan-Meier procedure estimated overall survival (OS). RESULTS A total of 1598 children were eligible for analysis; 1269 had a solid tumour with a negative correlation between SES and stage (Spearman rho = -.178; p < .001). Patients with solid tumours and lower SES showed proportionately higher numbers of stage III and IV disease (p < .01). This proportion decreased with higher SES categories. In the multivariate analyses adjusted for sex, age, tumour type and stage, higher SES was associated with lower mortality risk (p < .001), indicating that the impact of SES on survival was in excess of any effect that could be explained by lower stage disease alone. There was a strong positive correlation between race and SES (Fisher's exact tests, p < .001) across all groups and all SES strata. Five-year OS was 85.3% in children from H3 households versus 46.3% in children from H0 households (p < .001). CONCLUSION SES significantly impacts childhood cancer survival for children with solid tumours in South Africa. SES is a robust surrogate for race in South Africa as a prognostic metric of disease outcome in childhood cancer. Advocacy to increase social support for impoverished patients is essential to achieve equitable improvements in outcomes treated with standardised national treatment guidelines.
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Affiliation(s)
- Marc Hendricks
- Department of Paediatrics and Child Health, Haematology Oncology Service, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Annibale Cois
- Department of Global Health, Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jennifer Geel
- Department of Paediatrics and Child Health, Division of Paediatric Haematology Oncology, Charlotte Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Jaques van Heerden
- Department of Paediatrics and Child Health, Paediatric Haematology Oncology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
- Department of Paediatrics and Child Health, Paediatric Haematology and Oncology, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | - Collet Dandara
- University of Cape Town/South African Medical Research Council Platform for Pharmacogenomics Research and Translation, South African Medical Research Council, Cape Town, South Africa
- Department of Pathology & The Institute of Infectious Diseases and Molecular Medicine, Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Kharnita Mohamed
- Department of Anthropology, University of Cape Town, Cape Town, South Africa
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Division of Developmental Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- The Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Mariana Kruger
- Department of Paediatrics and Child Health, Paediatric Haematology Oncology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Hospital, Cape Town, South Africa
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Ssemata AS, Muhumuza R, Seeley J, Lombe DC, Mwamba M, Msadabwe S, Mwaka AD, Aggarwal A. Moving forward through consensus: a national Delphi approach to determine the top research priorities in prostate cancer in Uganda. BMJ Open 2023; 13:e075739. [PMID: 38035740 PMCID: PMC10689405 DOI: 10.1136/bmjopen-2023-075739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE To identify key areas for research in prostate cancer (PC) in the Ugandan context by establishing the major health system, socioeconomic and clinical barriers to seeking, reaching and receiving high-quality cancer care. DESIGN Modified Delphi Technique. SETTING Government and private-not-for-profit hospitals. METHODS We applied a two-stage modified Delphi technique to identify the consensus view across cancer experts. In round 1, experts received a questionnaire containing 21 statements drawn from a systematic review identifying the reason for the delay in accessing cancer care. Each statement was scored out of 20. Statements scoring ≥15 from over 70% of participants were prioritised for inclusion while statements for which <30% of participants gave a score of ≥15 were excluded. Sixteen statements were included in round 2 as they did not receive consensus for inclusion or exclusion. RESULTS We found that the top six research priority areas arise from challenges including: (1) lack of diagnostic services-ultrasound, laboratory tests and biopsy facilities; (2) high costs of services, for example, surgery, radiotherapy, hormone therapy are unaffordable to most patients, (3) lack of essential medicines, (4) limited radiotherapy capacity, (5) lack of awareness of cancer as a disease and low recognition of symptoms, (6) low healthcare literacy. The lack of critical surgical supplies, high diagnostic and treatment costs were ranked highest in order of importance in round 1. Round 2 also revealed lack of diagnostic services, unavailability of critical medicines, lack of radiotherapy options, high costs of treatments and lack of critical surgical supplies as the top priorities. CONCLUSION These research priority areas ought to be addressed in future research to improve prompt PC diagnosis and care in Uganda. There is need to improve the supply of high-quality affordable anticancer medicines for PC patients so as to improve the survivorship from the cancer.
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Affiliation(s)
- Andrew Sentoogo Ssemata
- Social Aspects of Health Across the Lifecourse, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Muhumuza
- Social Aspects of Health Across the Lifecourse, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | - Janet Seeley
- Social Aspects of Health Across the Lifecourse, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Amos Deogratius Mwaka
- Department of Internal Medicine, Mulago Hospital/Makerere University, Kampala, Uganda
- Department of Medicine, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Ajay Aggarwal
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK
- King's College London, London, UK
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Kidayi PL, Pakpour AH, Saboonchi F, Bray F, Manhica H, Mtuya CC, Serventi F, Aune RE, Mahande MJ, Björling G. Cross-Cultural Adaptation and Psychometric Properties of the Swahili Version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR45 among Breast Cancer Patients in Tanzania. Healthcare (Basel) 2023; 11:2467. [PMID: 37761665 PMCID: PMC10530899 DOI: 10.3390/healthcare11182467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Breast cancer is the most frequent cancer in women in Africa and contributes to premature death and poor quality of life. This study aimed to determine the validity, reliability, and psychometric properties of the Swahili version of EORTC QLQ-BR45 among women with breast cancer in Tanzania. A cross-sectional study design with non-probability convenience sampling was employed. Data were collected in two tertiary hospitals and one national cancer institute; 414 participants completed the EORTC-QLQ-C-30 and EORTC-QLQ-BR45. The reliability of QLQ-BR45 was measured using Cronbach's alpha and McDonald's Omega coefficients. The factor structure of EORTC QLQ-BR45 was assessed using confirmatory factor analysis. The internal consistencies for the five dimensions were all above 0.7 indicating satisfaction, except for systemic therapy side effects with a marginal value of 0.594 and significant correlations between the dimensions of QLQ-C30 and BR45. The final model fit well to the data, with the comparative fit index = 0.953, Tucker-Lewis index = 0.947, root mean square error of approximation = 0.041 (90% CI: 0.035, 0.046), and standardized root mean square residual = 0.072. In conclusion, the QLQ BR45 Swahili version displayed good reliability, validity, and psychometric properties and can be used in Swahili-speaking Sub-Saharan countries.
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Affiliation(s)
- Paulo L. Kidayi
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi 2240, Tanzania; (P.L.K.); (C.C.M.); (M.J.M.)
| | - Amir H. Pakpour
- Department of Nursing, School of Health and Welfare, Jönköping University, SE-55111 Jönköping, Sweden;
| | - Fredrik Saboonchi
- Department of Health Sciences, Swedish Red Cross University, SE-17176 Stockholm, Sweden;
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, F-69372 Lyon, France;
| | - Hélio Manhica
- Department of Health Promotion, Sophiahemmet University, SE-114 86 Stockholm, Sweden;
- Department of Global Public Health, Karolinska Institutet, SE-17177 Stockholm, Sweden
| | - Christina C. Mtuya
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi 2240, Tanzania; (P.L.K.); (C.C.M.); (M.J.M.)
| | - Furaha Serventi
- Cancer Care Centre, Kilimanjaro Christian Medical Centre, Moshi P.O. Box 3010, Tanzania;
| | - Ragnhild E. Aune
- Department of Material Sciences, Norwegian University of Technology and Science, NO-7491 Trondheim, Norway;
| | - Michael J. Mahande
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi 2240, Tanzania; (P.L.K.); (C.C.M.); (M.J.M.)
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi 2240, Tanzania
- Management and Development for Health (MDH), Dar es Salaam P.O Box 79810, Tanzania
| | - Gunilla Björling
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi 2240, Tanzania; (P.L.K.); (C.C.M.); (M.J.M.)
- Department of Nursing, School of Health and Welfare, Jönköping University, SE-55111 Jönköping, Sweden;
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-17176 Stockholm, Sweden
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