Quality of health care services and performance in public hospitals in Africa: A protocol for systematic review

Background: The delivery of high-quality health care services and performance is the main aim of all health care systems globally. This review objective is to determine the quality of health care services and performance in public hospitals in Africa through a systematic review and meta-analysis of existing studies.

Methods: The search will be conducted in pre-determined databases (e.g., PubMed), for eligible studies between 2000 and 2020, to identify studies published in English, which applied the service quality gap (SERVIQUAL) model to determine the quality of health care services and performance in public hospitals in Africa. The search will also include a review of reference lists of included studies for other eligible studies. Eligible studies will include experimental and observational studies. Two authors will independently screen the search output, select studies and extract data, resolve discrepancies by consensus and discussions. Two authors will use Cochrane risk of bias tools for experimental studies, and Hoy for observational studies. The review will also assess study quality and risk of bias using standardized tools. The review aims to provide comprehensive information on the quality of health care services and performance in public hospitals in Africa.

Discussion: Understanding patients’ or clients’ expectations and perceptions on the quality of health care services provided in the health care systems are very crucial in the improvement of the health status of the general population. The SERVIQUAL model is a standardized tool used to assess the quality gap of patients/clients perspectives on health care services in hospitals globally. The findings from this review will provide information on the quality gap of health care provided in public hospitals in SSA. Also, we anticipate that the findings will inform policymakers in health care systems on how to improve and maintain the quality of health care services in public hospitals in different African settings.

Systematic review registration number: PROSPERO CRD 420212264100 dated 25/07/2021

Burden and trend of colorectal cancer in 54 countries of Africa 2010–2019: a systematic examination for Global Burden of Disease

Background
Colorectal cancer plays significant role in morbidity, mortality and economic cost in Africa.

Objective
To investigate the burden and trends of incidence, mortality, and disability-adjusted life-years (DALYs) of colorectal cancer in Africa from 2010 to 2019.

Methods
This study was conducted according to Global Burden of Disease (GBD) 2019 analytic and modeling strategies. The recent GBD 2019 study provided the most updated and compressive epidemiological evidence of cancer incidence, mortality, years lived with disability (YLDs), years of life lost (YLLs), and DALYs.

Results
In 2019, there were 58,000 (95% UI: 52,000–65,000), 49,000 (95% UI: 43,000–54,000), and 1.3 million (95% UI: 1.14–1.46) incident cases, deaths and DALYs counts of colorectal cancer respectively in Africa. Between 2010 and 2019, incidence cases, death, and DALY counts of CRC were significantly increased by 48% (95% UI: 34–62%), 41% (95% UI: 28–55%), and 41% (95% UI: 27–56%) respectively. Change of age-standardised rates of incidence, death and DALYs were increased by 11% (95% UI: 1–21%), 6% (95% UI: − 3 to 16%), and 6% (95% UI: − 5 to 16%) respectively from 2010 to 2019. There were marked variations of burden of colorectal cancer at national level from 2010 to 2019 in Africa.

Conclusion
Increased age-standardised death rate and DALYs of colorectal cancer indicates low progress in CRC standard care-diagnosis and treatment, primary prevention of modifiable risk factors and implementation of secondary prevention modality. This serious effect would be due to poor cancer infrastructure and policy, low workforce capacity, cancer center for diagnosis and treatment, low finical security and low of universal health coverage in Africa.

Cancer Burden Among Arab-World Females in 2020: Working Toward Improving Outcomes

PURPOSE
Cancer is the leading cause of morbidity and mortality worldwide. This work presents the Arab-world females’ cancers (AFCs) statistics in 2020, compared with the 2018 AFCs statistics, the Arab-world male cancers statistics, and the world females’ cancers (WFCs) statistics in 2020. This can help set the stage for a better policy for cancer control programs and improve outcomes.

MATERIALS AND METHODS
A descriptive review of the 2020 Global Cancer Observatory concerning AFCs was performed. Data on various cancers were compiled and compared among the countries in the region and WFCs.

RESULTS
A total estimate of 244,317 new cases and 132,249 deaths is reported in AFCs; representing 2.65% and 2.99% of WFCs, respectively, with an average crude incidence/mortality ratio of 116.2 (/100,000 population)/62.9 (/100,000 population) and an age-standardized incidence/mortality ratio of 137.7(/100,000 population)/77.2(/100,000 population) compared with 238.8(/100,000 population)/114.6(/100,000 population) and 186(/100,000 population)/84.2(/100,000 population) of WFCs, respectively. Five-year prevalent cases were 585,295; 2.28% of WFCs. In comparison to males, females accounted for 47.8% of the whole population, 52.9% in incidence, 46.9% in mortality, and 56.9% in the prevalence of patients with cancer. Mortality-to-incidence ratio (MIR) was 0.54 (range 0.39-0.62 in Arab countries, compared with 0.48 globally), and it ranged from 0.14 to 0.97 in the 30 AFC types. Breast cancer was the most common cancer in incidence and mortality, with an MIR of 0.39.

CONCLUSION
The 2020 descriptive analysis of the females’ cancers in the Arab world revealed a relatively high MIR compared with females’ cancers worldwide; a lower MIR compared with the males; and comparable MIR to 2018 one. We call for more in-depth studies to determine the causes of these differences that might translate into actionable interventions and better outcomes.

The management of head and neck cancer in Africa. What lessons can be learned from African literature?

There is a significant dearth of contextually relevant information related to the management of head and neck cancer (HNC) in Africa. The aim of this letter was to put forward the findings from our larger systematic review to describe the current management of HNC patients in Africa and to identify gaps and present potential solutions. Sixty-six articles were included and analysed with descriptive statistics, a narrative synthesis, and thematic analysis. Surgical resection remains the primary medical intervention in Africa, whilst chemotherapy and radiation services remain limited. There was no mention of multidisciplinary team input in the management of these patients, including no description of any rehabilitative treatments. There are significant resource shortages ranging from access to medical equipment to both skilled medical and rehabilitative staff. The findings from this study imply that the management of HNC in Africa requires a possible transdisciplinary approach to improve access to services. Health professionals also need to explore a community-based level approach to care to improve access. There needs to be more context-specific research to improve contextually relevant teaching and practice in HNC.

Competencies for Nurses Regarding Psychosocial Care of Patients With Cancer in Africa: An Imperative for Action

Psychosocial care is considered an important component of quality cancer care. Individuals treated for cancer can experience biologic or physical, emotional, spiritual, and practical consequences (eg, financial), which have an impact on their quality of living. With the establishment of cancer centers in Africa, there is growing advocacy regarding the need for psychosocial care, given the level of unmet supportive care needs and high emotional distress reported for patients. Nurses are in an ideal position to provide psychosocial care to patients with cancer and their families but must possess relevant knowledge and skills to do so. Across Africa, nurses are challenged in gaining the necessary education for psychosocial cancer care as programs vary in the amount of psychosocial content offered. This perspective article presents competencies regarding psychosocial care for nurses caring for patients with cancer in Africa. The competencies were adapted by expert consensus from existing evidenced-based competencies for oncology nurses. They are offered as a potential basis for educational program planning and curriculum development for cancer nursing in Africa. Recommendations are offered regarding use of these competencies by nursing and cancer program leaders to enhance the quality of care for African patients with cancer and their family members. The strategies emphasize building capacity of nurses to engage in effective delivery of psychosocial care for individuals with cancer and their family members.

Role of Precision Oncology in Type II Endometrial and Prostate Cancers in the African Population: Global Cancer Genomics Disparities

Precision oncology can be defined as molecular profiling of tumors to identify targetable alterations. Emerging research reports the high mortality rates associated with type II endometrial cancer in black women and with prostate cancer in men of African ancestry. The lack of adequate genetic reference information from the African genome is one of the major obstacles in exploring the benefits of precision oncology in the African context. Whilst external factors such as the geography, environment, health-care access and socio-economic status may contribute greatly towards the disparities observed in type II endometrial and prostate cancers in black populations compared to Caucasians, the contribution of African ancestry to the contribution of genetics to the etiology of these cancers cannot be ignored. Non-coding RNAs (ncRNAs) continue to emerge as important regulators of gene expression and the key molecular pathways involved in tumorigenesis. Particular attention is focused on activated/repressed genes and associated pathways, while the redundant pathways (pathways that have the same outcome or activate the same downstream effectors) are often ignored. However, comprehensive evidence to understand the relationship between type II endometrial cancer, prostate cancer and African ancestry remains poorly understood. The sub-Saharan African (SSA) region has both the highest incidence and mortality of both type II endometrial and prostate cancers. Understanding how the entire transcriptomic landscape of these two reproductive cancers is regulated by ncRNAs in an African cohort may help elucidate the relationship between race and pathological disparities of these two diseases. This review focuses on global disparities in medicine, PCa and ECa. The role of precision oncology in PCa and ECa in the African population will also be discussed.

Strengthening the Health System as a Strategy to Achieving a Universal Health Coverage in Underprivileged Communities in Africa: A Scoping Review

Universal health coverage (UHC) is defined as people having access to quality healthcare services (e.g., treatment, rehabilitation, and palliative care) they need, irrespective of their financial status. Access to quality healthcare services continues to be a challenge for many people in low- and middle-income countries (LMICs). The aim of this study was to conduct a scoping review to map out the health system strengthening strategies that can be used to attain universal health coverage in Africa. We conducted a scoping review and qualitatively synthesized existing evidence from studies carried out in Africa. We included studies that reported interventions to strengthen the health system, e.g., financial support, increasing work force, improving leadership capacity in health facilities, and developing and upgrading infrastructure of primary healthcare facilities. Outcome measures included health facility infrastructures, access to medicines, and sources of financial support. A total of 34 studies conducted met our inclusion criteria. Health financing and developing health infrastructure were the most reported interventions toward achieving UHC. Our results suggest that strengthening the health system, namely, through health financing, developing, and improving the health infrastructure, can play an important role in reaching UHC in the African context.

Towards integration of transcranial Doppler in the management of severe TBI in LICs and LMICs: A cohort retrospective study

Background
Medical first-line management to fight against raised intracranial pressure due to severe TBI in LICs and LMICs is still precarious, especially with the lack of means for adequate monitoring of intracranial pressure.

Objective
In the cohort retrospective study, we aimed to show if the TCD could have an impact on decision-making to operate and on the GOS.

Methods
Patients treated at bi-institutional between March 2017 and July 2019, were included if they had Moderate to Severe TBI treated surgically. Variables associated with the outcome were tested using uni and multivariable analyses.

Results
One hundred and thirty-six TBI patients were admitted for management during the study period, 21 and 44 were excluded respectively because they were managed medically only, and were benign trauma. Seventy-one(71) patients were included in the final analysis. They had a mean age of 44.27 years old (+/− 15.99) at diagnosis and there was a male predominance (n = 59, 83,1%). 52(73.2%) of them benefited from TCD. The mean time between admission and the surgery in a cohort of patients from TCD monitoring was 6 h ± 4 vs 8 h ± 3 (P = 0.003). The mean GOS in the cohort group with non-TCD was 4,7 ± 1,1 versus 4,3 ± 1,1(P = 0.047)in the non-TCD cohort group. The paired test revealed statically significantly positive in the use of TCD for Severe TBI, Z = -3.859, P = 0.044 with a median effect (r = 0.23).

Conclusion
TCD has an impact on the early decision to go for DC and has a median effect on GOS.

Digital health in oncology in Africa: A scoping review and cross-sectional survey

Background
Low- and middle-income countries, especially in Africa, face a growing cancer burden. Adoption of digital health solutions has the potential to improve cancer care delivery and research in these countries. However, the extent of implementation and the impact of digital health interventions across the cancer continuum in Africa have not been studied.

Aims
To describe the current landscape of digital health interventions in oncology in Africa.

Methods
We conducted a scoping literature review and supplemented this with a survey. Following the PRISMA for Scoping Reviews guidelines, we searched literature in PubMed and Embase for keywords and synonyms for cancer, digital health, and African countries, and abstracted data using a structured form. For the survey, participants were delegates of the 2019 conference of the African Organization for Research and Training in Cancer.

Results
The literature review identified 57 articles describing 40 digital health interventions or solutions from 17 African countries, while the survey included 111 respondents from 18 African countries, and these reported 25 different digital health systems. Six articles (10.5%) reported randomized controlled trials. The other 51 articles (89.5%) were descriptive or quasi-experimental studies. The interventions mostly targeted cancer prevention (28 articles, 49.1%) or diagnosis and treatment (23 articles, 40.4%). Four articles (7.0%) targeted survivorship and end of life, and the rest were cross-cutting. Cervical cancer was the most targeted cancer (25 articles, 43.9%). Regarding WHO classification of digital interventions, most were for providers (35 articles, 61.4%) or clients (13, 22.8%), while the others were for data services or cut across these categories. The interventions were mostly isolated pilots using basic technologies such as SMS and telephone calls for notifying patients of their appointments or results, or for cancer awareness; image capture apps for cervical cancer screening, and tele-conferencing for tele-pathology and mentorship.

Generally positive results were reported, but evaluation focused on structure and process measures such as ease of use, infrastructure requirements, and acceptability of intervention; or general benefits e.g. supporting training and mentorship of providers, communication among providers and clients, and improving data collection and management. No studies evaluated individualized clinical outcomes, and there were no interventions in literature for health system managers although the systems identified in the survey had such functionality, e.g. inventory management. The survey also indicated that none of the digital health systems had all the functionalities for a comprehensive EHR, and major barriers for digital health were initial and ongoing costs, resistance from clinical staff, and lack of fit between the EHR and the clinical workflows.

Conclusion
Digital health interventions in oncology in Africa are at early maturity stages but promising. Barriers such as funding, fit between digital health tools and clinical workflows, and inertia towards technology, shall need to be addressed to allow for advancement of digital health solutions to support all parts of the cancer continuum. Future research should investigate the impact of digital health solutions on long-term cancer outcomes such as cancer mortality, morbidity and quality of lif

Breast Cancer Patients’ Experience about Involvement in Health Care: A Qualitative Study

Background: Patient involvement in health care is a basic patient’s right. Effective communication between the health care professional and the patient is associated with improved psychological functioning of the patient, adherence to treatment, and higher quality of life. Objective(s): This study aims to explore qualitatively breast cancer patients’ experience and satisfaction with their involvement in cancer care. Methods: This study was carried out among 30 women in different breast cancer care stages through in depth-interviews. The patients were purposively selected from surgery and oncology outpatient clinics and surgery inpatient wards in Medical Research Institute Hospital- Alexandria University, and in Ayadi El-Mostakbal Cancer Care Center – Ayadi El-Mostakbal Charity Foundation, Alexandria, Egypt. Results: Some patients mentioned that they did not know their diagnosis until late, others complained of the harsh non-empathetic way of breaking the news of their disease. Patients, generally, reported a little understanding of their treatment plan, they just followed physician’s instructions without receiving enough explanation. Patients on chemotherapy and radiotherapy expressed their unsatisfied need for information. Patients’ source of information was mainly other patients who suffered from the same disease. Patients, in general, were not familiar with the concept of giving feedback, it was perceived by the majority of them as equivalent to complaining. Some patients believed that complaining could put them in trouble such as receiving harsh blame or even delaying their medication. Conclusion: Patients’ narratives revealed poor involvement in health care and showed dissatisfaction of the majority of patients with their level of involvement.