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Mapping perioperative randomised controlled trials in Sub-Saharan Africa: a scoping review
Background: Surgical and anesthesia care is an integral component of universal healthcare coverage. In Sub-Saharan Africa (SSA), 93% of the population lacks access to essential surgical services. Post-surgery mortality in Africa is double the global average. The involvement of anesthesiologists is c...
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| Format: | Thesis |
| Language: | English English |
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Department of Anaesthesia and Perioperative Medicine
2025
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| _version_ | 1867613984126926848 |
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| access_status_str | Open Access |
| author | Collier, Laila |
| author2 | Biccard, Bruce |
| author_browse | Biccard, Bruce Collier, Laila |
| author_facet | Biccard, Bruce Collier, Laila |
| author_sort | Collier, Laila |
| collection | Thesis |
| description | Background: Surgical and anesthesia care is an integral component of universal healthcare coverage. In Sub-Saharan Africa (SSA), 93% of the population lacks access to essential surgical services. Post-surgery mortality in Africa is double the global average. The involvement of anesthesiologists is crucial for improved outcomes. Perioperative research can produce context-specific solutions to challenges faced in the perioperative period. SSA conducts fewer randomized controlled trials (RCTs) than high-income countries, limiting its contribution to global evidence. Objectives: Our primary objectives were to document the geographical distribution of included RCTs, describe their characteristics, and evaluate the reporting quality using the Consolidated Standards of Reporting Trials (CONSORT)-2010-checklist. Methods: We followed the PRISMA Scoping Reviews (PRISMAScR) Checklist. We searched MEDLINE, the Cochrane Library, and Scopus. We identified anesthesia-related RCTs within SSA published from 2000 to 2022. Two independent reviewers screened potential studies, and extracted data in duplicate, with disagreements resolved through consensus or a third reviewer. Quantitative analysis was done with STATA 16 and we compared RCT quality pre-CONSORT-2010 to post-CONSORT-2010, using Pearson's chi-squared test or Fisher's exact test (as applicable), considering p<0.05 as statistically significant. data were summarized narratively Results: Of 3319 records, 169 eligible RCTs were identified, randomizing 45376 participants, with a mean sample size of 98. Between the years 2000 and 2022, there was an exponential trend towards an increasing number of RCTs in SSA (y = 1,5619e0,1051x). The RCTs were from 16 countries in SSA. Most studies were single-country, single-center, led by authors from Nigeria (63/169, 37.3 %) and South Africa (41/169, 24.3%). Most interventions were conducted intraoperatively (n = 125/169, 74%). Pharmacotherapy interventions were most investigated (n = 64/169, 37.9%), followed by analgesic interventions (n = 42/169, 24.9%). The surgical discipline most investigated was obstetrics (n = 51/169, 30.2%). The reporting quality was generally poor, with most RCTs not adhering to CONSORT guidelines and failing to register on a trial registry. Conclusion: This scoping review provides a comprehensive overview of anesthesia-related RCTs in SSA, highlighting limitations such as small sample sizes, under-representation of high surgical burden disciplines, and poor reporting of study outcomes. The clinical trial capacity is limited to a few countries and institutions, and the methodological quality remains poor despite reporting guidelines. There is an opportunity to enhance context-appropriate RCTs in SSA by prioritizing high-quality research through collaborative efforts. Our findings serve as a resource for researchers, funders, and policymakers in anesthesia research in Africa to improve future RCT designs and reporting. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/42093 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:44:49.623Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Department of Anaesthesia and Perioperative Medicine |
| publisherStr | Department of Anaesthesia and Perioperative Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/42093 Mapping perioperative randomised controlled trials in Sub-Saharan Africa: a scoping review Collier, Laila Biccard, Bruce Hohlfeld, ASJ Surgical Anesthesia Sub-Saharan Africa Background: Surgical and anesthesia care is an integral component of universal healthcare coverage. In Sub-Saharan Africa (SSA), 93% of the population lacks access to essential surgical services. Post-surgery mortality in Africa is double the global average. The involvement of anesthesiologists is crucial for improved outcomes. Perioperative research can produce context-specific solutions to challenges faced in the perioperative period. SSA conducts fewer randomized controlled trials (RCTs) than high-income countries, limiting its contribution to global evidence. Objectives: Our primary objectives were to document the geographical distribution of included RCTs, describe their characteristics, and evaluate the reporting quality using the Consolidated Standards of Reporting Trials (CONSORT)-2010-checklist. Methods: We followed the PRISMA Scoping Reviews (PRISMAScR) Checklist. We searched MEDLINE, the Cochrane Library, and Scopus. We identified anesthesia-related RCTs within SSA published from 2000 to 2022. Two independent reviewers screened potential studies, and extracted data in duplicate, with disagreements resolved through consensus or a third reviewer. Quantitative analysis was done with STATA 16 and we compared RCT quality pre-CONSORT-2010 to post-CONSORT-2010, using Pearson's chi-squared test or Fisher's exact test (as applicable), considering p<0.05 as statistically significant. data were summarized narratively Results: Of 3319 records, 169 eligible RCTs were identified, randomizing 45376 participants, with a mean sample size of 98. Between the years 2000 and 2022, there was an exponential trend towards an increasing number of RCTs in SSA (y = 1,5619e0,1051x). The RCTs were from 16 countries in SSA. Most studies were single-country, single-center, led by authors from Nigeria (63/169, 37.3 %) and South Africa (41/169, 24.3%). Most interventions were conducted intraoperatively (n = 125/169, 74%). Pharmacotherapy interventions were most investigated (n = 64/169, 37.9%), followed by analgesic interventions (n = 42/169, 24.9%). The surgical discipline most investigated was obstetrics (n = 51/169, 30.2%). The reporting quality was generally poor, with most RCTs not adhering to CONSORT guidelines and failing to register on a trial registry. Conclusion: This scoping review provides a comprehensive overview of anesthesia-related RCTs in SSA, highlighting limitations such as small sample sizes, under-representation of high surgical burden disciplines, and poor reporting of study outcomes. The clinical trial capacity is limited to a few countries and institutions, and the methodological quality remains poor despite reporting guidelines. There is an opportunity to enhance context-appropriate RCTs in SSA by prioritizing high-quality research through collaborative efforts. Our findings serve as a resource for researchers, funders, and policymakers in anesthesia research in Africa to improve future RCT designs and reporting. 2025-11-03T13:03:00Z 2025-11-03T13:03:00Z 2025 2025-11-03T12:07:39Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/42093 en eng application/pdf Department of Anaesthesia and Perioperative Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Surgical Anesthesia Sub-Saharan Africa Collier, Laila Mapping perioperative randomised controlled trials in Sub-Saharan Africa: a scoping review |
| thesis_degree_str | Master's |
| title | Mapping perioperative randomised controlled trials in Sub-Saharan Africa: a scoping review |
| title_full | Mapping perioperative randomised controlled trials in Sub-Saharan Africa: a scoping review |
| title_fullStr | Mapping perioperative randomised controlled trials in Sub-Saharan Africa: a scoping review |
| title_full_unstemmed | Mapping perioperative randomised controlled trials in Sub-Saharan Africa: a scoping review |
| title_short | Mapping perioperative randomised controlled trials in Sub-Saharan Africa: a scoping review |
| title_sort | mapping perioperative randomised controlled trials in sub saharan africa a scoping review |
| topic | Surgical Anesthesia Sub-Saharan Africa |
| url | http://hdl.handle.net/11427/42093 |
| work_keys_str_mv | AT collierlaila mappingperioperativerandomisedcontrolledtrialsinsubsaharanafricaascopingreview |