Needle and syringe programs for reducing blood-borne diseases among people who inject drugs in sub-Saharan Africa: a scoping review protocol.

OBJECTIVE: This review will identify, explore, and map the literature on the characteristics and implementation modalities of needle and syringe programs for reducing blood-borne diseases among people who inject drugs in sub-Saharan Africa compared with the recommended standards by the World Health Organization and AIDS Projects Management Group. INTRODUCTION: Sub-Saharan Africa bears a disproportionate burden of infectious diseases and HIV/AIDS. Needle and syringe programs have been shown to be effective in preventing transmission of infections among those who inject drugs by providing them with sterile injection equipment. The programs may also serve as avenues for addressing other issues that affect this population. INCLUSION CRITERIA: This review will consider published and unpublished studies on needle and syringe programs as a method of preventing blood-borne infections among people who inject drugs in sub-Saharan Africa. The review will consider quantitative, qualitative, and mixed methods study designs, as well as systematic reviews and text and opinion papers. METHODS: The electronic databases to be searched include MEDLINE, African Journals Online, CINAHL, the Cochrane Library, Embase, and TRoPHI. We will also search sources of unpublished studies and gray literature (conference abstracts, theses, etc). The search will be restricted to studies in English, with no date limit. Data extraction will be done by two independent reviewers, guided by an extraction tool developed by the reviewers. Key information, such as author, reference, and findings relevant to the review questions, will be obtained. The results will be presented as graphs, figures, and tables accompanied by a narrative summary.

Prevalence of burnout among nurses in sub-Saharan Africa: a systematic review.

OBJECTIVE: The objective of this review was to determine the prevalence rates for burnout among nurses working in countries within the sub-Saharan Africa region. INTRODUCTION: Burnout is a response to chronic work-related stress. While there is ample information on its prevalence and risk factors in well-resourced settings in high-income countries, it remains poorly studied in the low- and middle-income countries of sub-Saharan Africa, which bear the larger share of the global burden of disease. INCLUSION CRITERIA: This review considered studies from sub-Saharan Africa that identified the prevalence of burnout among nurses using standard measurement tools. METHODS: A three-step search strategy was utilized to identify both published and unpublished studies in English. Databases (MEDLINE, Embase, CINAHL, and others) were searched from inception to January 2019. Study selection, critical appraisal, data extraction, and data synthesis were conducted according to JBI methodology. RESULTS: A total of 12 studies (n = 2543 nurses) from seven African countries were included in this review. Eight of these studies were cross-sectional by design while the others were either exploratory, longitudinal, surveys, or descriptive. Ten studies were deemed to be at low risk of bias. According to the Maslach Burnout Inventory (seven studies, n = 1923), the prevalence of emotional exhaustion was 66% (95% confidence interval [CI], 37% to 89%), 60% (95% CI, 31% to 85%) for depersonalization, and 49% (95% CI, 19% to 80%) for low personal achievement. The overall prevalence of burnout among studies that utilized the Professional Quality of Life Scale (three studies, n = 337) was 87% (95% CI, 54% to 100%). One study reported a prevalence of 51% (95% CI, 44% to 57%) using the Copenhagen Burnout Inventory (n = 237), and the final study reported a prevalence of 33% (95% CI, 21% to 47%) using an unspecified measuring tool (n = 46). CONCLUSIONS: Regardless of the measuring tool used, nurses in sub-Saharan Africa experience high levels of burnout in all its dimensions.

Clinicopathologic Features and Early Surgical Outcome of Astrocytomas in Eldoret, Kenya.

BACKGROUND: Astrocytomas are primary central nervous system tumors arising from astrocytes and accounting for up to 37.8% of all brain tumors seen in hospital-based studies from Africa. Despite being common, their patterns and short-term outcomes remain poorly studied in Kenya. MATERIALS AND METHODS: A prospective, descriptive study involving consecutive patients with a histological diagnosis of astrocytoma seen in three hospitals located in Eldoret, Kenya. Clinicopathologic characteristics and outcomes were recorded and patients followed up for 12 weeks. RESULTS: Thirty-one patients were recruited over a 1-year period. Majority of them were female (51.6%). Headache (83.9%) and focal neurological deficits (64.5%) were the most common presenting features. Among patients with high-grade tumors, mean duration of illness was 106.03 ± 162.16 days, median functional status was Karnofsky performance status (KPS) score 50, mean tumor size was 110.22 ± 46.16 cm3, and median magnetic resonance imaging (MRI) score was 17. Among patients with low-grade astrocytomas, mean duration of illness was 213.03 ± 344.93 days, median functional status was KPS score 40, mean tumor size was 53.49 ± 54.96 cm3 and median MRI score was 9. Glioblastoma multiforme (GBM) (71%) and diffuse astrocytoma (22.6%) were the predominant histological subtypes. The median Ki-67 proliferative index was 6% for pilocytic astrocytoma, 1.6% for diffuse astrocytoma, and 60% for GBM. Systemic and regional surgical complications occurred in 6.5% and 38.7% of patients, respectively. In-hospital mortality was 19.4% and increased to 25.8% at 12 weeks. The KPS score at discharge was 50 and improved to 60 at 12 weeks. Only 9.7% of patients had acceptable functional status at 12 weeks follow-up. CONCLUSIONS: In this locality, headache, focal neurological deficits, and reduced functional status are the most common presenting features of astrocytomas while GBM is the most common histological subtype. Tumors are highly proliferative and in the short-term, both surgical and functional outcome are suboptimal.

Burden of brain tumors in low- and middle-income countries: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to determine the best available evidence on the burden of brain tumors in low- and middle-income countries (LAMICs). More specifically, the objective is to determine the incidence and prevalence rates for brain tumors in LAMICs.

Accuracy of clinical stroke scores for distinguishing stroke subtypes in resource poor settings: A systematic review of diagnostic test accuracy.

BACKGROUND: Stroke is the second leading cause of death globally. Computerized tomography is used to distinguish between ischemic and hemorrhagic subtypes, but it is expensive and unavailable in low and middle income countries. Clinical stroke scores are proposed to differentiate between stroke subtypes but their reliability is unknown. MATERIALS AND METHODS: We searched online databases for studies written in English and identified articles using predefined criteria. We considered studies in which the Siriraj, Guy's Hospital, Besson and Greek stroke scores were compared to computerized tomography as the reference standard. We calculated the pooled sensitivity and specificity of the clinical stroke scores using a bivariate mixed effects binomial regression model. RESULTS: In meta-analysis, sensitivity and specificity for the Siriraj stroke score, were 0.69 (95% CI 0.62-0.75) and 0.83 (95% CI 0.75-0.88) for ischemic stroke and 0.65 (95% CI 0.56-0.73) and 0.88 (95% CI 0.83-0.91) for hemorrhagic stroke. For the Guy's hospital stroke score overall sensitivity and specificity were 0.70 (95% CI 0.53-0.83) and 0.79 (95% CI 0.68-0.87) for ischemic stroke and 0.54 (95% CI 0.42-0.66) and 0.89 (95% CI 0.83-0.94) for hemorrhagic stroke. CONCLUSIONS: Clinical stroke scores are not accurate enough for use in clinical or epidemiological settings. Computerized tomography is recommended for differentiating stroke subtypes. Larger studies using different patient populations are required for validation of clinical stroke scores.