Serious adverse drug reactions in sub‐Saharan Africa in the era of antiretroviral treatment: A systematic review

Mouton, Johannes P.; Jobanputra, Nicole; Tatz, Gayle; Cohen, Karen

doi:10.1002/prp2.875

Cited by 4 publications

(4 citation statements)

References 56 publications

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“…Systematic reviews of ADE occurrence in different settings are scarce in Africa, thereby making a comparison to earlier results difficult. A review by Moulton et al [ 10 ] reviewed the burden of serious ADRs in Sub-Saharan Africa and reported a median proportion of admissions attributed to ADRs was 4.8%, which was comparable to the finding from our study (6.0%). In addition, the prevalence of ADE-related hospital admissions aligned with data from international literature [ 96 , 97 ].…”

Section: Discussionsupporting

confidence: 89%

“…Two reviewers assessed the methodological quality of included observational studies using the ten-question criteria proposed by Smyth et al [ 15 ], considering that the widely used risk assessment approaches for systematic review such as Cochrane Risk of Bias tool and GRADE were primarily appropriate for randomized controlled trials. This ten-point quality assessment instrument employed in the current review was developed specifically for studies investigating ADEs in clinical settings and has been applied by previous systematic reviews [ 7 , 10 , 16 , 17 ]. We replaced the term severity with “seriousness or severity” in Smyth et al’s.…”

Section: Methodsmentioning

confidence: 99%

“…There is a sparse amount of evidence offering a comprehensive assessment of the burden of ADEs occurring in the outpatient or community settings in Africa. There have been two systematic reviews carried out in Africa [ 7 , 10 ], but these reviews had a focus on hospital settings without inclusion of community settings and adverse reactions induced by specific pharmaceutical interventions (e.g., antiretroviral therapy). The exclusion of outpatient and community settings suggest that previous studies provided an incomprehensive insight into the true burden of ADRs in Africa.…”

Section: Introductionmentioning

confidence: 99%

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Variation of adverse drug events in different settings in Africa: a systematic review

Nyame,

Hu,

Xue

et al. 2024

Eur J Med Res

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Background Adverse drug events (ADEs) represent challenges affecting Africa’s healthcare systems owing to the increased healthcare expenditure and negative health outcomes of ADEs. Objectives We aimed to systematically review published studies on ADEs and synthesize the existing evidence of ADE prevalence in Africa. Methods Studies reporting on ADE occurrence in African settings and published from Jan 1, 2000 to Oct 1, 2023 were identified by searching PubMed, EBSCO, Science Direct, and Web of Science. Studies that either articulately investigated ADEs caused by clinical condition (such as HIV patients) or ADEs caused by exposure to specific drug(s) (such as antibiotics) were considered specific and the remaining were general. Grouped ADE prevalence rates were described using median and interquartile range (IQR). PROSPERO registration (CRD42022374095). Results We included 78 observational studies from 15 African countries that investigated the prevalence of ADEs leading to hospital admissions (17 studies), developed during hospitalizations (30 studies), and captured in the outpatient departments (38 studies) or communities (4 studies). Twelve studies included multiple settings. The median prevalence of ADE during hospitalization was 7.8% (IQR: 4.2–21.4%) and 74.2% (IQR: 54.1–90.7%) in general and specific patients, respectively. The ADE-related fatality rate was 0.1% and 1.3% in general and specific patients. The overall median prevalence of ADEs leading to hospital admissions was 6.0% (IQR: 1.5–9.0%); in general, patients and the median prevalence of ADEs in the outpatient and community settings were 22.9% (IQR: 14.6–56.1%) and 32.6% (IQR: 26.0–41.3%), respectively, with a median of 43.5% (IQR: 16.3–59.0%) and 12.4% (IQR: 7.1–28.1%) of ADEs being preventable in general and specific patients, respectively. Conclusions The prevalence of ADEs was significant in both hospital and community settings in Africa. A high ADE prevalence was observed in specific patients, emphasizing important areas for improvement, particularly in at-risk patient groups (e.g., pediatrics, HIV, and TB patients) in various settings. Due to limited studies conducted in the community setting, future research in this setting is encouraged.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Variation of adverse drug events in different settings in Africa: a systematic review

Nyame,

Hu,

Xue

et al. 2024

Eur J Med Res

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“…In agreement with the current findings, a systematic review by Mouton et al . [ 113 ] found a hospital mortality proportion of 2.5% to 16% among HIV-infected adults on HAART in SSA. According to a report from research conducted in seven teaching hospitals in Ethiopia, 22% of HIV-positive patients experience mild to life-threatening ARV drug toxicity [ 114 ].…”

Section: Discussionmentioning

confidence: 99%

Highly active antiretroviral therapy is necessary but not sufficient. A systematic review and meta-analysis of mortality incidence rates and predictors among HIV-infected adults receiving treatment in Ethiopia, a surrogate study for resource-poor settings

Woldegeorgis,

Asgedom,

Habte

et al. 2024

BMC Public Health

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Background Owing to the introduction of highly active antiretroviral therapy (HAART), the trajectory of mortality and morbidity associated with human immunodeficiency virus (HIV) infection has significantly decreased in developed countries. However, this remains a formidable public health challenge for people living with HIV in resource-poor settings. This study was undertaken to determine the pooled person-time incidence rate of mortality, analyze the trend, and identify predictors of survival among HIV-infected adults receiving HAART. Methods Quantitative studies were searched in PubMed, Embase, Scopus, Google Scholar, African Journals Online, and Web of Science. The Joana Briggs Institute critical appraisal tool was used to assess the quality of the included articles. The data were analyzed using the random-effects Dersimonian-Laird model. Results Data abstracted from 35 articles involving 39,988 subjects were analyzed. The pooled person-time incidence rate of mortality (all-cause) was 4.25 ([95% uncertainty interval (UI), 3.65 to 4.85]) per 100 person-years of observations. Predictors of mortality were patients aged ≥ 45 years (hazard ratio (HR), 1.70 [95% UI,1.10 to 2.63]), being female (HR, 0.82 [95% UI, 0.70 to 0.96]), history of substance use (HR, 3.10 [95% UI, 1.31 to 7.32]), HIV positive status non disclosure (HR, 3.10 [95% UI,1.31 to 7.32]), cluster of differentiation 4 + T cell - count < 200 cells/mm3 (HR, 3.23 [95% UI, [2.29 to 4.75]), anemia (HR, 2.63 [95% UI, 1.32 to 5.22]), World Health Organisation classified HIV clinical stages III and IV (HR, 3.02 [95% UI, 2.29 to 3.99]), undernutrition (HR, 2.24 [95% UI, 1.61 to 3.12]), opportunistic infections (HR, 1.89 [95% UI, 1.23 to 2.91]), tuberculosis coinfection (HR, 3.34 [95% UI, 2.33 to 4.81]),bedridden or ambulatory (HR,3.30 [95% UI, 2.29 to 4.75]), poor treatment adherence (HR, 3.37 [95% UI,1.83 to 6.22]), and antiretroviral drug toxicity (HR, 2.60 [95% UI, 1.82 to 3.71]). Conclusion Despite the early introduction of HAART in Ethiopia, since 2003, the mortality rate has remained high. Therefore, guideline-directed intervention of identified risk factors should be in place to improve overall prognosis and increase quality-adjusted life years.

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Moderate and serious adverse reactions to antimicrobials among hospitalized children: A systematic review

Ramos,

do Sacramento,

de Silva

et al. 2024

Brit J Clinical Pharma

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AimsThis systematic review aimed to investigate the occurrence of moderate and severe adverse drug reactions (ADRs) to antimicrobials among hospitalized children.MethodsThe PubMed/Medline, Cochrane Library, Embase, Web of Science, Scopus, Lilacs and CINAHL databases were searched in April 2023 to systematically review the published data describing the characteristics of moderate and severe ADRs to antimicrobials among hospitalized children. The search was carried out without date restrictions, up to the search date (April, 2023).ResultsAt the end of the selection process, 30 articles met the inclusion criteria. Cutaneous reactions were the primary serious clinical manifestations in most articles (19/30), followed by erythema multiforme (71 cases), Stevens–Johnson syndrome (72 cases), and toxic epidermal necrolysis (22 cases). The main antimicrobials involved in moderate and severe ADRs were penicillins, cephalosporins and sulfonamides. Regarding the primary outcomes, 30% (9/30) of the articles reported deaths, and 46.7% (14/30) of studies reported increased lengths of hospital stay, need for intensive care, and transfer to another hospital. Regarding the main interventions, 10% (3/30) of the articles mentioned greater monitoring, suspension, medication substitution or prescription of specific medications for the symptomatology.ConclusionsThe findings of this review could be used to identify areas for improvement and help health professionals and policymakers develop strategies. In addition, we emphasize the importance of knowing about ADRs so that there is adequate management to avoid undesirable consequences.

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Serious adverse drug reactions in sub‐Saharan Africa in the era of antiretroviral treatment: A systematic review

Cited by 4 publications

References 56 publications

Variation of adverse drug events in different settings in Africa: a systematic review

Variation of adverse drug events in different settings in Africa: a systematic review

Highly active antiretroviral therapy is necessary but not sufficient. A systematic review and meta-analysis of mortality incidence rates and predictors among HIV-infected adults receiving treatment in Ethiopia, a surrogate study for resource-poor settings

Moderate and serious adverse reactions to antimicrobials among hospitalized children: A systematic review

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