Systematic review exploring the impact of socio-cultural factors on pain management approaches in sub- saharan africa

Aim The experience and expression of pain are influenced by numerous factors of which culture and the society plays a major role especially in SSA. However, few studies have focused on the impact of cultural influences on pain assessment and management in SSA. This systemic review examines pain prevalence and its intensity/severity, the socio-cultural factors that affect pain management and the extent to which socio-cultural practices influence pain assessment and management in SSA. Methods Applying the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted. Seven electronic databases were searched, and a strict inclusion and exclusion criteria applied to the retrieve articles along with a robust filtering to identify eligible peer reviewed literature. The review process concluded with 24 eligible articles and following the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was applied to assess the quality of the included literature and thematic narrative analysis was conducted. Results The analysis findings identified that there are sociocultural barriers to effective pain management from the perspective of different subcultures in SSA. The evidence suggests that religious/spiritual and inherited beliefs, along with limited knowledge and health literacy influence the experience and pain management approaches applied in SSA. In addition, results indicate that, resource constraints and cultural and societal norms impact on access and use of pain management among the population in SSA. Conclusion Healthcare professionals should be aware of how the society, cultural and beliefs of their patients influence their expression of pain and subsequent pain management. Under-treatment or over-treatment might occur if health workers are unaware or do not consider the cultural norms associated with pain and pain expression, due to the subjective and individual nature of pain. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was registered with the Academic Ethics Committee for Bangor University and was granted exemption from requiring ethics approval. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Not Applicable All relevant data are within the manuscript and its Supporting Information files.