Incidence rate of mortality and its predictors among tuberculosis and human immunodeficiency virus coinfected patients on antiretroviral therapy in Ethiopia: systematic review and meta-analysis

Background

Tuberculosis (TB) is the leading cause of death among HIV-infected adults and children globally. Therefore, this study was aimed at determining the pooled mortality rate and its predictors among TB/HIV-coinfected patients in Ethiopia.

Methods

Extensive database searching was done via PubMed, EMBASE, SCOPUS, ScienceDirect, Google Scholar, and Google from the time of idea conception on March 1, 2023, to the last search via Google on March 31, 2023. A meta-analysis was performed using the random-effects model to determine the pooled mortality rate and its predictors among TB/HIV-coinfected patients. Heterogeneity was handled using subgroup analysis, meta-regression, and sensitivity analysis.

Results

Out of 2,100 records, 18 articles were included, with 26,291 total patients. The pooled incidence rate of mortality among TB/HIV patients was 12.49 (95% CI: 9.24-15.74) per 100 person-years observation (PYO); I2 = 96.9%. The mortality rate among children and adults was 5.10 per 100 PYO (95% CI: 2.15-8.01; I2 = 84.6%) and 15.78 per 100 PYO (95% CI: 10.84-20.73; I2 = 97.7%), respectively. Age ≥ 45 (pooled hazard ratios (PHR) 2.58, 95% CI: 2.00- 3.31), unemployed (PHR 2.17, 95% CI: 1.37-3.46), not HIV-disclosed (PHR = 2.79, 95% CI: 1.65-4.70), bedridden (PHR 5.89, 95% CI: 3.43-10.12), OI (PHR 3.5, 95% CI: 2.16-5.66), WHO stage IV (PHR 3.16, 95% CI: 2.18-4.58), BMI < 18.5 (PHR 4.11, 95% CI: 2.28-7.40), anemia (PHR 4.43, 95% CI: 2.73-7.18), EPTB 5.78, 95% CI: 2.61-12.78 significantly affected the mortality. The effect of TB on mortality was 1.95 times higher (PHR 1.95, 95% CI: 1.19-3.20; I2 = 0) than in TB-free individuals.

Conclusions

The mortality rate among TB/HIV-coinfected patients in Ethiopia was higher compared with many African countries. Many clinical factors were identified as significant risk factors for mortality. Therefore, TB/HIV program managers and clinicians need to design an intervention early.

Prevalence of posttraumatic stress disorder and associated factors among displaced people in Africa: a systematic review and meta-analysis

Background

The number of people who have been displaced from their homes due to violence, conflict, and natural disasters. The displaced persons are vulnerable to PTSD; however, being women, individuals with lower socio-economic status and intense exposure to physical assault are more vulnerable. The reviews stated that the pooled prevalence of PTSD among refugees in high-income countries was higher than the general population. However, there has been no review done on PTSD among displaced persons in Africa. Therefore, the aim of this review was to summarise the most recent data evidence on the pooled prevalence of posttraumatic stress disorder and the pooled effect of associated factors on adult displaced people in Africa.

Methods

We used an appropriate guideline for systematic reviews and meta-analyses reports, which is the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This review protocol was registered in PROSPERO (CRD42023411371). The publications were identified from PubMed/Medline, EMBASE, the Cochrane Library, Scopus databases, and other grey searches of Google Scholar and World Health Organisation (WHO) reports. The data was extracted in Microsoft Excel, and then it will be imported into STATA 11.0 for analysis.

Results

We have included 10 studies conducted in African countries with 5287 study participants. In this meta-analysis, the pooled prevalence of PTSD among displaced people in Africa was 55.64 (95% CI: 42.76-68.41%). Further, in subgroup analysis regarding the study participants, the pooled prevalence of PTSD among internally displaced people and refugees was 56.35% and 54.04%, respectively. Among the associated factors, being female, unemployed, and depression were significantly related to PTSD among displaced people.

Conclusions

In this review, the pooled prevalence of PTSD among displaced people in Africa was high. Demographic characteristics (female, single, and unemployed), substance use disorder, and depression were risk factors for PTSD among displaced people. This finding might help the stakeholders (mental health policy makers, administrators, and mental health professionals) to address the prevention, early screening, and management of PTSD among displaced people and to give attention to more vulnerable bodies.

Systematic review registration

PROSPERO, identifier CRD42023411371.

Prevalence of premenstrual syndrome and its associated factors in Africa: a systematic review and meta-analysis

Background

Clinical research and epidemiological studies have shown that many women experience physical and behavioral symptoms that begin during the luteal phase of the menstrual cycle and terminate around the onset of menses; this is called premenstrual syndrome. The reviews stated that the pooled prevalence of premenstrual syndrome was around 50 percent. However, there has been no review done on premenstrual syndrome in Africa. Therefore, the aim of this systematic review and meta-analysis was to summarize the most recent data evidence on the pooled prevalence of premenstrual syndrome and its pooled effect of associated factors in Africa.

Method

We used an appropriate guideline for systematic reviews and meta-analyses reports, which is the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). This review protocol was registered in PROSPERO (CRD42023414021). The publications were identified from PubMed/Medline, EMBASE, Scopus databases, and other grey searches. The included papers were the original data that reported the prevalence of premenstrual syndrome and associated factors published, in English, and papers available online from January 1, 2000, to May 30, 2023. The data was extracted in Microsoft Excel, and then it would be imported into STATA 11.0 for analysis.

Results

We have included 16 studies conducted in African countries with 6530 study participants. In this meta-analysis, the pooled prevalence of premenstrual syndrome among the reproductive-age participants in Africa was 46.98 (95% CI: 28.9-65.06%). Further, in subgroup analysis, the pooled prevalence of premenstrual syndrome was 57.32% in Nigeria, 43.8% in Ethiopia, and 38.6% among university students and 66.04% among secondary school students. Among associated factors, the early age of menarche was significantly related to premenstrual syndrome.

Conclusion

In this review, the pooled prevalence of premenstrual syndrome in Africa was high. Among factors, the early age of menarche was a risk factor for premenstrual syndrome. This finding might help the stakeholders (mental health policy makers, administrators, and mental health professionals) to address prevention, early screening, and management of PMS among reproductive-age women, and to give attention to more vulnerable bodies.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023414021.