Introduction Circumstantial evidence suggests that a high proportion of cases of epilepsy in countries across sub-Saharan Africa (SSA) remain undiagnosed. The magnitude of the burden is unknown. Screening tools offer promise for early detection and prevalence estimation that will enable evidence-informed management of epilepsy in SSA. This review will systematically assess the accuracy and reliability of screening tools for detecting epilepsy in communities and primary care settings in SSA.Methods and analysis Relevant databases, non-database sources and grey literature will be searched for studies on epilepsy screening tools. PubMed, LILACS, CINAHL, PsycINFO and Google Scholar, from inception to 31 May 2026, will be searched for studies on screening tools (questionnaires) administered by non-expert physicians to populations or hospital/clinic-based cohorts with no language restrictions. The following search terms will be used: screening tool, screening questionnaire, screening test, screening instrument, diagnostic tool, diagnostic accuracy, epilepsy, sensitivity, specificity, true positive, false positive, true negative and false negative and SSA. All countries in SSA will be included as search terms. Cochrane databases, African Journals Online, African Index Medicus, HINARI and Preprint and Thesis repositories will also be searched. Reference lists of potentially relevant studies will be reviewed, and experts will be contacted to identify additional studies missed in our searches. Study selection (using a pretested study selection flow chart), data extraction (using a validated data extraction form) and risk-of-bias assessment (using the revised Quality Assessment of Diagnostic Accuracy Studies-2) will be performed independently by at least two reviewers, and any discrepancies will be resolved through discussion. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) will be estimated from 2-by-2 tables of true positives, false positives, true negatives and false negatives. Possible causes of heterogeneity between studies will be assessed through pre-specified subgroup analyses. A meta-analysis will be conducted using a bivariate random-effects model to summarise sensitivity, specificity and DOR per patient. A summary receiver operating characteristic curve will be plotted to determine the overall diagnostic performance of the index tests. Sensitivity analyses will be conducted to test the robustness of pooled estimates of screening accuracy, and all estimates will be presented with their 95% CIs.Ethics and dissemination This study will synthesise empirical evidence from publicly available published and unpublished studies, and hence no ethical approval is required. An eligible study with serious ethical issues will be excluded from the analysis and the reasons for exclusion will be documented. The review findings will be shared with all relevant stakeholders, including healthcare providers, patient advocate groups, agencies involved in implementing epilepsy care and policies, civil society, social services providers and researchers. The review findings will be shared widely at scientific symposia and conferences, and the final report will be published in a high-impact-factor peer-reviewed journal.PROSPERO registration number CRD42024566976.
Background Health insurance coverage in sub-Saharan Africa (SSA) remains low and digital premium payment systems have been suggested as a potential solution to increase enrolment and retention. This systematic review will collate and distill empirical evidence on the impact of digital premium payment in scaling health insurance coverage and retention and access to health service delivery in SSA.Methods This systematic review protocol has been prepared following robust methods, and it is reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will conduct searches through relevant databases, including PubMed, CINAHL, LILACS, HINARI, African Journals Online, Google Scholar, Scopus, Web of Science, Trip Pro and TOXNET from 2007 to 30 June 2026, without language restriction for studies that evaluated digital premium payment systems and reported health insurance enrolment or retention rates. The search terms and concepts include: ‘national health insurance’, ‘health insurance coverage’, ‘insurance enrolment’, ‘digital premium’, ‘e-payment’, ‘online payment’, ‘electronic payment’, ‘mobile payment’, ‘telepayment’ and ‘cashless payment’, together with their alternate terms and synonyms, singular and plural forms as well as British and American spelling. The names of the countries in SSA will be included as search terms. Grey literature including dissertation repositories, national health insurance databases and conference proceedings will be searched. Reference list of retrieved articles will be reviewed, and where necessary, experts working in the field of national health insurance will be contacted for knowledge about completed studies not captured by our searches. Two reviewers will independently screen studies, extract data (using pretested data extraction form developed from Microsoft Excel) and assess risk of bias in the included studies using the quality assessment tool for Risk Of Bias In Non-randomized Studies - of Exposures. Any disagreements will be resolved through discussion between the reviewers. Heterogeneity will be explored graphically for overlapping CIs and statistically using the I2-statistic. We will combine dichotomous outcomes using risk ratio and for continuous data mean difference employing random-effects meta-analysis and presenting weighted effect estimates with their 95% (CIs). Subgroup analysis will be performed to assess the impact of heterogeneity and sensitivity analyses to test the robustness of the pooled effect estimates. The overall level or certainty of evidence will be assessed using Grading of Recommendations, Assessment, Development, and Evaluation.Ethics and dissemination This systematic review will collate empirical data on publicly available published and unpublished primary studies and no ethical approval is required. However, an eligible study with serious ethical issues will be excluded from the analysis and the reasons for exclusion documented. The review findings will be shared with key stakeholders and health authorities, agencies involved in digital premium health insurance and policymakers. The review results will be presented at scientific conferences and symposia, and a manuscript will be submitted for publication in a high impact factor journal.Trial registration number CRD42024576134.
Background: Anorectal disease has a significant impact on patients’ quality of life (QoL), and surgical treatment may further diminish QoL. The purpose of this study was to identify the prevalence of anorectal diseases, its management and improving the patient’s quality of life. Methods: Study is carried out in various health screening camps of eastern Nepal, the study was done in patients who attended the health screening camp with in period of three months. (Nov 2024-Jan 2025) The objective of study is to find prevalence of anorectal disease, its management and improving patient’s quality of life. All patients with anorectal conditions presented and managed at our camp were included. Surgical intervention was done in the hospital. Excluded were patients less than 20 years old, pregnant and lactating mother. Results: The patients with anorectal diseases presenting in camp with ages more than 20 years old, both genders were included. All patients were examined by surgeon. 366 patients with anorectal diseases were included in study. Most patients were female 256(69.95%) and male 110(30.05%). Most common anorectal diseases were Hemorrhoids (59.56%), Anal Fissure (12.84%), Rectal polyp (9.56%), and Fistula in Ano (8.75%). Out of 366 patients with anorectal disease, 146 were given surgical treatment and 220 were managed with conservative treatment. This study may contribute to epidemiological knowledge about the prevalence of anorectal disorders. Conclusion: Hemorrhoids, anal fissure and rectal polyp, were the common anorectal condition
BACKGROUND:Epilepsy is a chronic neurological disorder often associated with stigma, misconceptions, and considerable caregiving responsibilities, particularly in low- and middle-income countries such as Ghana. Caregivers are vital yet frequently undervalued in epilepsy care, confronting emotional, social, and health system-related, access-related and financial barriers. This study explored the lived experiences of caregivers of individuals with epilepsy, highlighting their roles, the difficulties they encounter, and their coping strategies within sociocultural and healthcare contexts. METHODS:A qualitative study was conducted with 10 caregivers (5 males and 5 females) of people living with epilepsy in the Shai-Osudoku and Ningo-Prampram districts of Ghana. Participants, including mothers, fathers, and a wife, were purposively selected for in-depth interviews. Transcribed data were analyzed using reflexive thematic analysis with the support of NVivo software. RESULTS:Caregivers took on multiple roles, such as monitoring seizures, managing medications, coordinating care, and navigating diverse care systems, including biomedical, traditional, and spiritual treatment options. Their experiences were marked by emotional and psychological stress, ongoing fear and uncertainty, financial strain from out-of-pocket expenses, reduced income, and social exclusion due to stigma. Limited access to affordable healthcare and antiseizure medications further hindered their ability to seek care and maintain treatment continuity. Despite these obstacles and challenges, caregivers showed resilience through reliance on family support, religious coping strategies, and practical knowledge. CONCLUSION:The findings underscore the need for contextually grounded epilepsy care models that address the interplay of sociocultural beliefs, financial constraints, and barriers to healthcare access. Strengthening and improving caregiver support through accessible mental health services, targeted education, improved access to affordable antiseizure medications, and community-based stigma-reduction awareness initiatives is essential to reduce caregiver burden and improve continuity and quality of epilepsy care in Ghana and similar contexts.
OBJECTIVE:Epilepsy imposes a disproportionate burden in Africa, yet there are no reliable epidemiological data from Ghana. This community-based cross-sectional survey addressed this gap in southeastern Ghana, incorporating an analytical comparison of confirmed cases and age- and sex-matched controls. METHODS:We conducted a population-based cross-sectional study using a validated tool and a three-stage screening approach to estimate the prevalence of active epilepsy in the two Ghanaian districts of Shai-Osudoku and Ningo-Prampram. The three-stage approach consisted of population screening, detailed individual assessment, and clinical confirmation by specialists. To identify factors associated with epilepsy, we conducted a cross-sectional analysis comparing confirmed cases with age- and sex-matched controls randomly selected from the same population. Trained fieldworkers administered standardized questionnaires to capture sociodemographic data and historical risk exposures. RESULTS:The attrition-adjusted prevalence of active epilepsy was 8.84 per 1000 people (95% confidence interval [CI]: 8.00-9.68), higher in Shai-Osudoku (12.30 per 1000) than in Ningo-Prampram, and greatest in remote rural areas. Prevalence was higher among males (10.53 per 1000) and peaked at ages 20-29 years (11.44 per 1000). The poorest quintile had a prevalence three times that of the wealthiest. In children (≤16 years), fever-related convulsions (adjusted odds ratio [aOR] = 94.75; 95% CI: 17.40-515.96; p < .001) and history of cerebral/severe malaria (1.03; 95% CI: 1.01-1.06; p = .003) were strongly associated with epilepsy; younger males had higher odds (2.78; 95% CI: 1.12-6.88). In adults, household members with epilepsy (6.21; 95% CI: 2.56-15.11), family history (3.55; 95% CI: 1.13-11.19), head injury (24.45; 95% CI: 3.07-194.60), and household ownership of cats (1.76; 95% CI: 1.10-2.81) or pigs (2.26; 95% CI: 1.10-4.66) were significant risk factors. SIGNIFICANCE:Our findings highlight a high burden of epilepsy in southeastern Ghana, with variations observed across geographic, demographic, and socioeconomic groups. Modifiable risks such as head injury and cerebral or severe malaria highlight urgent needs for targeted prevention, improved health care access, and poverty alleviation strategies.
