Determinants of Dyslipidemia in Africa: A Systematic Review and Meta-Analysis.

Background: Dyslipidemia is a common public health problem in Africa. It has emerged as an important cardiovascular risk factor. It has been steadily increasing due to economic growth, urbanization, and unhealthy dietary pattern. Therefore, it is essential to identify determinants of dyslipidemia to prevent the condition and reduce its long-term sequel. Methods: Combinations of search terms with Boolean operators were used to retrieve studies from PubMed, EMBASE, Cochrane Database, Cinahl, Scopus, Mednar, and Google Scholar. The methodological quality of each article was evaluated based on the 2017 Joanna Briggs Institute (JBI) Critical Appraisal checklist for prevalence studies. After evaluation of each study against these criteria, studies with a minimum score of 7 or above out of 9 JBI checklists were included. We included articles presented in the English language. The Cochrane Q test was used to assess the heterogeneity across studies. The visual assessment of publication bias was done by creating a funnel plot. The possible causes of heterogeneity were explored by subgroup analyses. Egger's weighted regression test was used to assess the presence of publication bias. Statistical analyses were done by using the STATA software version 14. Result: A total of 24 articles involving 37,902 participants from 10 African countries were included. The overall pooled prevalence of dyslipidemia was 52.8 (95% CI 40.8-64.9). Individuals with a body mass index (BMI) >25.0 kg/m2 and waist circumference (WC) >94 cm were, respectively, 2.36 (95% CI (1.33-4.18), p < 0.001) and 2.33 (95% CI (0.75-0.29) p < 0.001) times more likely to develop dyslipidemia than those with lower values. Furthermore, patients with diabetes mellitus (DM) and hypertension (HTN) were 2.32 (95% CI (0.89-6.05) p < 0.001) and 2.05 (95% CI (1.31-3.21), p < 0.001) times more likely to present with dyslipidemia than non-diabetic patients and those without HTN. Conclusion: This study revealed that the prevalence of dyslipidemia is relatively high among study participants in African countries and the independent predictors of dyslipidemia were BMI >25.0 kg/m2, WC > 94 cm, raised blood glucose level, and raised blood pressure. Therefore, there should be a pressing public health measure to prevent, identify, and treat dyslipidemia with the special emphasis on obese, diabetic, and hypertensive patients.

Experience and Challenges of Objective Structured Clinical Examination (OSCE): Perspective of Students and Examiners in a Clinical Department of Ethiopian University.

BACKGROUND: Invented nearly half a century ago, Objective Structured Clinical Examination (OSCE) is overwhelmingly accepted clinical skills assessment tool and has been used worldwide for evaluating and teaching learners' competences in health care disciplines. Regardless of factors affecting the attributes, OSCE is considered as reliable and powerful tool with certain validity evidences. In spite of its advantages and various promotion efforts, the progress of OSCE implementation in Ethiopian public universities has not been satisfactory. Therefore, the objective of this study was to explore the experience and challenges of OSCE implementation from the perspective of clinical year-II medical students and their examiners in Ob-Gyn Department of Jimma University. METHODS: Forty-nine students and seven examiners voluntarily participated in Ob-Gyn Department where OSCE has been used as one of summative assessment methods. Qualitative study design using structured open-ended questionnaire as a tool and descriptive phenomenology as underpinning method were employed. Collaizzi's descriptive analysis was used as phenomenological analysis approach. RESULT: Poor organization, inadequate student preparation time, and inadequate number and duration of stations were thematically emerged as umbrellas of factors negatively affecting OSCE implementation. Satisfaction with OSCE was the only theme with findings that encourage OSCE implementation. CONCLUSION: There should be team approach, shared responsibility and proper planning among faculty to minimize hindering factors of OSCE implementation. Besides faculty development on OSCE, the department should improve skill lab utilization arranging schedule for both students and faculty members to increase guided students' exposure to simulation-based learning and ultimately enhance OSCE implementation.

Methods, methodological challenges and lesson learned from phenomenological study about OSCE experience: Overview of paradigm-driven qualitative approach in medical education.

Qualitative research approach could be as important as quantitative one, particularly in medical education, as long as it meets the common goal of both-improving the quality of education. In contrary to the end-i.e. achieving the common goals, the means of both approaches of inquiry is different. Their dissimilarity in the means or process is not confined to data collection techniques, study designs or analysis methods; but, they also differ in assumptions about the world, reality, science and knowledge. Implicitly or explicitly, these assumptions are revealed in a researcher's discussion about philosophical assumptions and research paradigms. The researcher's inclination towards any of paradigms and assumption in light of the most common philosophical concepts such as ontology, epistemology and methodology results in choice of either of the dominant research paradigms to follow such as objectivism/positivism and interpretivisim/constructivism. This is common practice in the quantitative-qualitative dichotomy of research world disregarding the emerging mixed approach with predominantly pragmatism paradigm. Besides framing the methodology of the study, researcher's explicit description of philosophical assumptions and paradigms helps readers easily understand study findings. Many authors from both dominant traditions fail to describe this important aspect of the research in their published works. In our study, the ontological and epistemological assumptions led us choose interpretivist/constructivist paradigm and phenomenological qualitative approach with Collaizi's descriptive phenomenological analysis adapted to our context. The experience and lesson learned from the study found to be worse sharing in a modified and extended construct of methodology part. Therefore, this article deals with philosophical positions, research paradigms and traditions that led to the specific qualitative approach from the perspective of methodology part in our study about objective structure clinical examination (OSCE) experience in a medical department.