Effectiveness of team-based care interventions in improving blood pressure outcomes among adults with hypertension in Africa: a systematic review and meta-analysis.

OBJECTIVE: We evaluated the effectiveness of team-based care interventions in improving blood pressure (BP) outcomes among adults with hypertension in Africa. DESIGN: Systematic review and meta-analysis. DATA SOURCE: PubMed, CINAHL, EMBASE, Cochrane Library, HINARI and African Index Medicus databases were searched from inception to March 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included randomised controlled trials (RCTs) and pre-post study designs published in English language focusing on (1) Adults diagnosed with hypertension, (2) Team-based care hypertension interventions led by non-physician healthcare providers (HCPs) and (3) Studies conducted in Africa. DATA EXTRACTION AND SYNTHESIS: We extracted study characteristics, the nature of team-based care interventions, team members involved and other reported secondary outcomes. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and the National Heart, Lung, and Blood Institute assessment tool for pre-post studies. Findings were summarised and presented narratively including data from pre-post studies. Meta-analysis was conducted using a random effects model for only RCT studies. Overall certainty of evidence was determined using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool for only the primary outcome (systolic BP). RESULTS: Of the 3375 records screened, 33 studies (16 RCTs and 17 pre-post studies) were included and 11 RCTs were in the meta-analysis. The overall mean effect of team-based care interventions on systolic BP reduction was -3.91 mm Hg (95% CI -5.68 to -2.15, I² = 0.0%). Systolic BP reduction in team-based care interventions involving community health workers was -4.43 mm Hg (95% CI -5.69 to -3.17, I² = 0.00%) and nurses -3.75 mm Hg (95% CI -10.62 to 3.12, I² = 42.0%). Based on the GRADE assessment, we judged the overall certainty of evidence low for systolic BP reduction suggesting that team-based care intervention may result in a small reduction in systolic BP. CONCLUSION: Evidence from this review supports the implementation of team-based care interventions across the continuum of care to improve awareness, prevention, diagnosis, treatment and control of hypertension in Africa. PROSPERO registration number CRD42023398900.

30-day in-hospital stroke case fatality and significant risk factors in sub-Saharan-Africa: A systematic review and meta-analysis.

Existing studies investigating 30-day in-hospital stroke case fatality rates in sub-Saharan Africa have produced varying results, underscoring the significance of obtaining precise and reliable estimations for this indicator. Consequently, this study aimed to conduct a systematic review and update of the current scientific evidence regarding 30-day in-hospital stroke case fatality and associated risk factors in sub-Saharan Africa. Medline/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNet (encompassing PsycINFO and PsychArticle), Google Scholar, and Africa Journal Online (AJOL) were systematically searched to identify potentially relevant articles. Two independent assessors extracted the data from the eligible studies using a pre-tested and standardized excel spreadsheet. Outcomes were 30-day in-hospital stroke case fatality and associated risk factors. Data was pooled using random effects model. Ninety-three (93) studies involving 42,057 participants were included. The overall stroke case fatality rate was 27% [25%-29%]. Subgroup analysis revealed 24% [21%-28%], 25% [21%-28%], 29% [25%-32%] and 31% [20%-43%] stroke case fatality rates in East Africa, Southern Africa, West Africa, and Central Africa respectively. Stroke severity, stroke type, untyped stroke, and post-stroke complications were identified as risk factors. The most prevalent risk factors were low (<8) Glasgow Coma Scale score, high (≥10) National Institute Health Stroke Scale score, aspiration pneumonia, hemorrhagic stroke, brain edema/intra-cranial pressure, hyperglycemia, untyped stroke (stroke diagnosis not confirmed by neuroimaging), recurrent stroke and fever. The findings indicate that one in every four in-hospital people with stroke in sub-Saharan Africa dies within 30 days of admission. Importantly, the identified risk factors are mostly modifiable and preventable, highlighting the need for context-driven health policies, clinical guidelines, and treatments targeting these factors.

The prevalence and determinants of non-communicable diseases among Ghanaian adults: A survey at a secondary healthcare level.

The current epidemiological transition of diseases in Ghana necessitates understanding their burden and the associated context-specific risk factors to inform disease prevention strategies. To determine the prevalence and determinants of selected Non-Communicable Diseases (NCDs) among patients seeking healthcare services in a secondary health facility in Ghana. A facility-based survey was conducted among adult patients 18 years and above between May and July 2021, using a multi-stage sampling approach. Data regarding the prevalence of NCDs, participants' socio-demographics and lifestyle factors of NCDs were obtained using Modified STEPwise Approach to NCD Risk Factor Surveillance (STEPS). The Chi-square test and regression analysis were performed to identify the risk factors of NCDs at P < 0.05. The participants comprised 480 patients with a mean age of 37.7±16.5 years, and 57.7% (277/480) of them were females. The overall prevalence of the selected NCDs was 26.7% (CI = 0.23-0.31), of which hypertension (22.7%) was the most prevalent. More than half (54.2%) of the participants engaged in alcohol consumption and 54% were physically inactive. The odds of developing NCDs were higher in females (CI = 1.32-4.10, P = 0.004), older adults (CI = 4.11-20.68, P <0.001), overweight/obese adults (CI = 1.65-4.70, P < 0.001), family history (CI = 0.15-0.46, P<0.001), and alcohol consumption (CI = 0.12-0.40, P < 0.001). There was an overall high prevalence of NCDs, strongly influenced by the participants' age, sex, BMI, alcohol consumption, and family history. These determinants should be highlighted as part of the campaign for preventive action plans.

Physiotherapy practice patterns in the management of patients with knee osteoarthritis: A national survey on the use of clinical practice guidelines.

BACKGROUND AND PURPOSE: Most published clinical practice guidelines (CPGs) endorsed therapeutic exercises, education, and body weight management as the gold standard for managing knee osteoarthritis (OA). However, it is difficult to ascertain whether the physiotherapy practice pattern in Ghana uniformly conforms to the generally accepted standard. Our aim was to describe the patterns of physiotherapists' practice with respect to Knee OA in a low-resource setting. METHOD: A web-based nationwide cross-sectional survey was performed among registered members of the Ghana Physiotherapy Association. Consented participants were sampled into the study through a purposive sampling method. A self-designed and validated questionnaire was administered to obtain the participants' awareness of CPGs, while the selection of modalities by the physiotherapists was based on a clinical vignette. Exploratory analysis of data was performed for the association of the age, sex, education, and the number of patients managed per week with the awareness of CPGs, using the Chi-square test at a significance level of p < 0.05. RESULTS: Of the total 165 participants, only 148 responded and were included for data analysis. Sixty-one (41.2%) of the 148 respondents were aware of specific CPGs for knee OA management, even though 98 (66.2%) utilized OA-specific outcome measures for management evaluation. Majority of the participants (90.5%) commonly selected therapeutic exercises, and 83.8% utilized education for weight management. Transcutaneous electrical nerve stimulation and ice therapy were selected by 68.2% and 66.2% of the respondents, respectively. The number of patients managed per week was not significantly associated (p > 0.05) with the awareness of CPGs. DISCUSSION: Our findings show high utilization of therapeutic exercises and patients' education in the management of knee OA despite the low awareness of OA-specific CPGs. IMPLICATION FOR PHYSIOTHERAPY: The inclusion of passive modalities coupled with the physiotherapists' low awareness underpins the need for continuing education on condition-specific CPGs.

COVID-19 vaccine acceptance among health care workers in Africa: A systematic review and meta-analysis.

INTRODUCTION: Coronavirus Disease (COVID-19) vaccine acceptance, and hesitancy amongst Health Care Workers (HCWs) on the African continent have been examined through observational studies. However, there are currently no comprehensive reviews among these cadre of population in Africa. Hence, we aimed to review the acceptance rate and possible reasons for COVID-19 vaccine non-acceptance/hesitancy amongst HCWs in Africa. METHODS: We searched Medline/PubMed, Google Scholar, and Africa Journal Online from January, 2020 to September, 2021. The Newcastle-Ottawa Quality Assessment tool adapted for cross-sectional studies was used to assess the quality of the retrieved studies. DerSimonian and Laird random-effects model was used to pool the COVID-19 vaccine acceptance rate. Sub-group and sensitivity analyses were performed. Reasons for COVID-19 vaccine hesitancy were also systematically analyzed. RESULTS: Twenty-one (21) studies were found to be eligible for review out of the 513 initial records. The estimated pooled COVID-19 vaccine acceptance rate was 46% [95% CI: 37%-54%]. The pooled estimated COVID-19 vaccine acceptance rate was 37% [95% CI: 27%-47%] in North Africa, 28% [95% CI: 20%-36%] in Central Africa, 48% [CI: 38%-58%] in West Africa, 49% [95% CI: 30%-69%] in East Africa, and 90% [CI: 85%-96%] in Southern Africa. The estimated pooled vaccine acceptance was 48% [95% CI:38%-57%] for healthcare workers, and 34% [95% CI:29%-39%] for the healthcare students. Major drivers and reasons were the side effects of the vaccine, vaccine's safety, efficacy and effectiveness, short duration of the clinical trials, COVID-19 infections, limited information, and social trust. CONCLUSION: The data revealed generally low acceptance of the vaccine amongst HCWs across Africa. The side effects of the vaccine, vaccine's safety, efficacy and effectiveness, short duration of the clinical trials, COVID-19 infections, limited information, and social trust were the major reasons for COVID-19 hesitancy in Africa. The misconceptions and barriers to COVID-19 vaccine acceptance amongst HCWs must be addressed as soon as possible in the continent to boost COVID-19 vaccination rates in Africa.

Impact of COVID-19 pandemic on acute stroke admissions and case-fatality rate in lower-income and middle-income countries: a protocol for systematic review and meta-analysis.

INTRODUCTION: The current review primarily aims to ascertain the impact of COVID-19 on stroke admission as well as stroke case fatality in Low-income and Middle-Income Countries (LMICs). METHODS AND ANALYSIS: Four international databases (PubMed/Medline, Google Scholar, African Journals Online, Latin American and Caribbean Health Sciences Literature) and one preprint database (medRxiv). Studies will be included if they are conducted in LMICs, all stroke types without age and language restriction, from December 2019 to 31 December 2021. Two authors will screen the titles and abstracts against the prespecified eligibility criteria for inclusion in the review, and then repeat the process after retrieving the full text. Joanna Briggs critical appraisal checklist for analytical cross-sectional studies will be used for the quality assessment and risk of bias by two coauthors. The characteristics of the studies will be presented and summarised in a table. We aim to perform meta-analyses on a pooled proportional change in acute stroke admissions and case fatality with 95% CI using a random-effects meta-analysis. Publication bias will be assessed using funnel plot and Egger's regression test if ≥10 studies are involved. A sub group analysis will be performed to determine the sources of heterogeneity. Leave-one-out sensitivity analysis will be performed to examine the impact of a single study on the overall pool estimate. ETHICS AND DISSEMINATION: Ethical approval is not required as this is secondary research and will use reported data in scientific literature. A full manuscript will be submitted to a reputable peer-review journal for publication and disseminated electronically and in print. PROSPERO REGISTRATION NUMBER: CRD42021281580.

Factors Associated with Serious Injuries among Adolescents in Ghana: Findings from 2012 Global School Health Survey.

INTRODUCTION: Injuries are of public health concern and the leading cause of residual disability and death among teenagers, especially in low- and middle-income countries (LMICs). In Ghana, the burden of injury among adolescents is under-reported. Hence, the study sought to determine the prevalence of serious injuries (SI) and the potential factors influencing these injuries among school children in Ghana. METHODS: This study was conducted in Ghana among Junior High School (JHS) and senior high school students (SHS) using the 2012 Global School-Based Student Health Survey (GSHS) data. The GSHS employed two-stage cluster sampling method. Serious injuries (SI) and independent factors were measured via self-administered questionnaires. Pearson chi-square test between each explanatory variable and serious injuries was conducted and the level of statistical significance was set at 5%. The significant variables from the chi-square test were selected for multiple logistic regression analysis. Multiple logistic regression was performed to estimate the adjusted odds ratio (AOR) at 95% confidence interval (CI). RESULTS: The prevalence of SI in the past 12 months was 66% [CI=61.8-70.2] . The most common cause of SI was fall, 36%. The common types of injuries were cut/stab wounds and broken/dislocated bone. In the multiple logistic regression analysis, after controlling for other variables, educational level (AOR = 0.64, CI = 0.44-0.90, p < 0.015), suicidal ideation (AOR = 1.58, CI = 1.00-2.48, p < 0.002), suicidal attempt (AOR = 1.88, CI = 1.29-2.72, p < 0.001), having at least one close friend (AOR = 1.49, CI = 1.17-1.89, p < 0.002), school truancy (AOR = 1.66, CI = 1.31-2.09, p < 0.000), smoking marijuana (AOR = 2.64, CI = 1.22-5.69), and amphetamine use (AOR = 2.95, CI = 1.46-5.69) were independently associated with SI. CONCLUSION: The findings of the study established a high prevalence of SI among adolescents in Ghana, with cut/stab wound and broken/dislocated bone being the most reported type of injuries. This study also revealed that factors such as educational level, suicidal ideation, suicidal attempt, at least one close friend, school truancy, smoking marijuana, and amphetamine use are associated with SI among the adolescents. Therefore, pragmatic interventional programs should be targeted at these factors to curb the rate of SI among junior and senior school students.

Knowledge, attitude and practice of physiotherapists towards health promotion in Ghana.

BACKGROUND: Physiotherapists are well equipped to address health promotion issues with their patients and the public. However, no studies have been conducted in Ghana to assess the knowledge, attitude and practice of physiotherapists towards health promotion. OBJECTIVES: This study therefore seeks to determine the knowledge, attitude and practice of physiotherapists towards health promotion in Ghana. METHODS: This cross-sectional study was conducted at some selected physiotherapy departments in health facilities across Ghana. Ninety-one registered physiotherapists living and working in Ghana were recruited for this study. A closed-ended self-administered questionnaire was used to collect data on the demographics, knowledge, attitude and practice of physiotherapists towards health promotion. The scores for each section were calculated individually, and the final knowledge, attitude and practices score was obtained by calculating the total of the three sections. Statistical Package for Social Sciences version 22.0 was employed to analyse all the study variables. RESULTS: Physiotherapists' knowledge was 72%, attitude 84% and practice 87% towards health promotion. The association between the physiotherapists' knowledge of health promotion and practice was significant with Pearson's chi-square test (p = 0.013). But there was no significant association between knowledge and attitude of physiotherapists towards health promotion (p = 0.097). CONCLUSION: Physiotherapists have very good knowledge, attitude and practice towards health promotion in Ghana. This is essential for better integration into the scope of physiotherapy practice, and therefore, the health promotion policy in Ghana should be revised to include physiotherapists, because they are experts in exercise prescription and physical activity. CLINICAL IMPLICATIONS: The outcomes of this study could provide the impetus for physiotherapists to include health promotion in clinical and community services for primary prevention of non-communicable diseases as well as secondary and tertiary prevention of disability to promote functional independence.