Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis.

OBJECTIVES: The objective of this study is to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa. STUDY DESIGN: Systematic review and meta-analysis. METHODS: We searched PubMed, EMBASE, CINAHL, African Journals OnLine, Web of Science and Scopus electronic databases from January 2000 to 2019. All observational studies published in the English language that reported cervical cancer uptake and/or predictors in Sub-Saharan Africa were initially screened. We assessed methodological quality using the Newcastle-Ottawa Scale. An inverse variance-weighted random-effects model meta-analysis was performed to estimate the pooled uptake and odds ratio (OR) of predictors with a 95% confidence interval (CI). The I2 test statistic was used to check between-study heterogeneity, and the Egger's regression statistical test was used to check publication bias. RESULTS: We initially screened 3537 citations and subsequently 29 studies were selected for this review, which included a total of 36,374 women. The uptake of cervical cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I2 = 98.5%). A meta-analysis of seven studies showed that knowledge about cervical cancer increased screening uptake by nearly five times (OR: 4.81; 95% CI: 3.06, 7.54). Other predictors of cervical screening uptake include educational level, age, Human Immune deficiency Virus (HIV) status, contraceptive use, perceived susceptibility and awareness about screening locations. CONCLUSIONS: Cervical screening uptake is low in Sub-Saharan Africa as a result of several factors. Health outreach and promotion programmes to target these identified predictors are required.

HIV infection and unknown HIV status among tuberculosis patients in Ethiopia: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: Each case of human immunodeficiency virus (HIV) infection worsens the global HIV situation, leads to the failure to achieve tuberculosis (TB) control targets worldwide, and impacts on the use of health service resources. We determined the prevalence of HIV infection among TB patients and the proportion of TB patients with unknown HIV status in Ethiopia. METHODS: We searched PubMed, EMBASE, Google Scholar and Web of Science electronic databases. Heterogeneity of the included studies was checked using the I² statistic and publication bias was assessed using funnel plots and Egger's regression statistical test. We employed a random-effects model to determine the pooled prevalence of HIV infection and unknown HIV status. A sensitivity analysis was also conducted to examine the effect of possible outliers on the overall estimate. RESULTS: The prevalence of HIV infection among TB patients and the proportion of TB patients with unknown HIV status was respectively 23.4% (95%CI 19.6-27.2) and 6.4% (95%CI 1.7-11.0). Based on geographical location, the prevalence of HIV infection was 31.4% (95%CI 19.2-43.6) in Amhara Region, 23.2% (95%CI 9.9-36.5) in Oromia, 20.9% (95%CI 17.8-24.0) in Addis Ababa and 16.5% (95%CI 12.0-21.0) in Southern Nations, Nationalities and Peoples' Region (SNNPR). CONCLUSION: In Ethiopia, almost one in four TB patients is infected with HIV. Given the epidemiological variation of Ethiopia, responsive, integrated sustainable programmes for HIV and TB are essential to minimise the epidemics of HIV infection and TB.

Long-term cognitive trajectories and heterogeneity in patients with schizophrenia and their unaffected siblings.

OBJECTIVE: This study aimed to assess the heterogeneity and stability of cognition in patients with a non-affective psychotic disorder and their unaffected siblings. In addition, we aimed to predict the cognitive subtypes of siblings by their probands. METHOD: Assessments were conducted at baseline, 3 and 6 years in 1119 patients, 1059 siblings and 586 controls from the Genetic Risk and Outcome of Psychosis (GROUP) study. Group-based trajectory modeling was applied to identify trajectories and clustered multinomial logistic regression analysis was used for prediction modeling. A composite score of eight neurocognitive tests was used to measure cognitive performance. RESULTS: Five stable cognitive trajectories ranging from severely altered to high cognitive performance were identified in patients. Likewise, four stable trajectories ranging from moderately altered to high performance were found in siblings. Siblings had a higher risk of cognitive alteration when patients' alteration was mild (OR = 2.21), moderate (OR = 5.70), and severe (OR = 10.07) compared with patients with intact cognitive function. The familial correlation coefficient between pairs of index patients and their siblings was 0.27 (P = 0.003). CONCLUSIONS: The cognitive profiles identified in the current study might be suitable as endophenotypes and could be used in future genetic studies and predicting functional and clinical outcomes.