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撒哈拉以南非洲镰状细胞病负担与挑战的批判性综述

A Critical Review of Sickle Cell Disease Burden and Challenges in Sub-Saharan Africa.

作者信息

Adigwe Obi Peter, Onoja Solomon Oloche, Onavbavba Godspower

机构信息

Office of the Director General, National Institute for Pharmaceutical Research and Development, Abuja, Federal Capital Territory, Nigeria.

Department of Medical Laboratory Sciences, University of Nigeria, Enugu, Nigeria.

出版信息

J Blood Med. 2023 May 31;14:367-376. doi: 10.2147/JBM.S406196. eCollection 2023.

Abstract

Sickle cell disease is caused by an abnormality of the β-globin gene and is characterised by sickling of the red blood cells. Globally, sub-Saharan African countries share the highest burden of the disease. This study aimed at critically reviewing studies focusing on challenges of sickle cell anaemia in sub-Saharan Africa. A literature search was carried out in five major databases. Articles that met the inclusion criteria were included in the bibliometric review and critical analysis. A majority of the studies were undertaken in the West African region (85.5%), followed by Central Africa (9.1%). Very few studies had been undertaken in East Africa (3.6%), whilst the Southern African region had the fewest studies (1.8%). Distribution in relation to country revealed that three quarters of the studies were carried out in Nigeria (74.5%), followed by the Democratic Republic of the Congo (9.1%). According to healthcare settings, a strong majority of the studies were undertaken in tertiary health care facilities (92.7%). Major themes that emerged from the review include interventions, cost of treatment, and knowledge about sickle cell disease. Public health awareness and promotion as well as improving the quality of sickle cell centers for prompt management of patients with sickle cell disorder was identified as a critical strategy towards reducing the burden of the disease in sub-Saharan Africa. To achieve this, governments in countries located in this region need to adopt a proactive strategy in addressing gaps that have been identified in this study, as well as instituting other relevant measures, such as continuous media engagement and public health interventions relating to genetic counselling. Reforms in other areas that can help reduce the disease burden, include training of practitioners and equipping sickle cell disease treatment centers according to World Health Organization specifications.

摘要

镰状细胞病由β-珠蛋白基因异常引起,其特征是红细胞镰变。在全球范围内,撒哈拉以南非洲国家承担着最重的疾病负担。本研究旨在严格审查聚焦于撒哈拉以南非洲镰状细胞贫血挑战的研究。在五个主要数据库中进行了文献检索。符合纳入标准的文章被纳入文献计量学综述和批判性分析。大多数研究在西非地区开展(85.5%),其次是中非(9.1%)。东非开展的研究极少(3.6%),而南部非洲地区的研究最少(1.8%)。按国家分布显示,四分之三的研究在尼日利亚进行(74.5%),其次是刚果民主共和国(9.1%)。根据医疗机构类型,绝大多数研究在三级医疗机构开展(92.7%)。综述中出现的主要主题包括干预措施、治疗成本以及对镰状细胞病的认知。提高公众健康意识和促进宣传,以及改善镰状细胞病中心的质量以便及时管理镰状细胞病患者,被确定为减轻撒哈拉以南非洲地区疾病负担的关键策略。要实现这一目标,该地区各国政府需要采取积极策略来解决本研究中发现的差距,并制定其他相关措施,如持续的媒体宣传和与遗传咨询相关的公共卫生干预措施。其他有助于减轻疾病负担的领域的改革包括培训从业人员,并按照世界卫生组织的规范配备镰状细胞病治疗中心。

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