Prevalence of metabolic syndrome among HIV-positive and HIV-negative populations in sub-Saharan Africa-a systematic review and meta-analysis

BACKGROUND: Metabolic syndrome (MetS) is a constellation of conditions that increase the risk of cardiovascular diseases. It is an emerging concern in sub-Saharan African (SSA) countries, particularly because of an increasingly aging population and lifestyle changes. There is an increased risk of MetS and its components among people living with Human immune deficiency syndrome (HIV) individuals; however, the prevalence of metabolic syndrome in the SSA population and its differential contribution by HIV status is not yet established. This systematic review and meta-analysis were conducted to estimate the pooled prevalence of metabolic syndrome in people living with HIV and uninfected populations, its variation by sub-components. METHODS: We performed a comprehensive search on major databases-MEDLINE (PubMed), EBSCOhost, and Cochrane Database of Systematic Reviews and Web of sciences for original epidemiological research articles that compared proportions of the MetS and its subcomponents between people living with HIV and uninfected patients and published between January 1990-December 2017. The inclusion criteria were adults aged ≥ 18 years, with confirmed HIV status. We assessed the risk of bias using a prevalence studies tool, and random effect meta-analyses were used to compute the pooled overall prevalence. RESULTS: A total of four cross-sectional studies comprising 496 HIV uninfected and 731 infected participants were included in the meta-analysis. The overall prevalence of MetS among people living with HIV was 21.5% (95% CI 15.09-26.86) versus uninfected 12.0% (95% CI 5.00-21.00%), with substantial heterogeneity. The reported relative risk estimate for MetS among the two groups was twofold (RR 1.83, 95% CI 0.98-3.41), with an estimated predictive interval of 0.15 to 22.43 and P = 0.055 higher for the infected population. Hypertension was the most prevalent MetS sub-components, with diverse proportions of people living with HIV (5.2-50.0%) and uninfected (10.0-59.0%) populations. CONCLUSIONS: The high range of MetS prevalence in the HIV-infected population compared to the uninfected population highlights the possible presence of HIV related drivers of MetS. Also, the reported high rate of MetS, irrespective of HIV status, indicates a major metabolic disorder epidemic that requires urgent prevention and management programs in SSA. Similarly, in the era of universal test and treat strategy among people living with HIV cohorts, routine check-up of MetS sub-components is required in HIV management as biomarkers. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016045727

Observational Assessment of Pre-Analytical Errors in Request Format and Phlebotomy Practice in Hematology Tests at Hawassa University Comprehensive Specialized Hospital in Sidama Zone, Southern Ethiopia

Bedasa Addisu,1 Amanuel Kelem,2 Agete Tadewos Hirigo3 1Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Amhara, Ethiopia; 2Department of Medical Laboratory Sciences, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia; 3School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, EthiopiaCorrespondence: Bedasa Addisu, Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Berhan University, PO Box 445, Debre Berhan, Ethiopia, Tel +251912496933, Email [email protected]: The significance of quality in laboratories necessitates the implementation of comprehensive quality management throughout the entire laboratory process, encompassing the pre-analytical to post-analytical phases. The pre-analytical phase, which plays a crucial role in laboratory services, is particularly significant, as it is responsible for approximately 70% of errors. Enhancing the quality of the pre-analytical phase is essential to ensure the effectiveness of laboratory services and safeguard patient safety.Objective: The objective of this study was to assess errors made in the request format and phlebotomy procedures during the collection of blood samples for hematology laboratory tests between April and June 2019.Methods: A cross-sectional study was carried out at Hawassa University College of Medicine and Health Sciences on 393 samples with their respective request forms. The study employed a systematic sampling technique and utilized well-structured checklists to gather all the necessary data for hematology laboratory tests, including a thorough evaluation of the requested form. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) software version 21.Results: A total of 393 hematological samples from their respective request forms were analyzed in this study. Generally, the request forms did not contain all the necessary information, and each form had at least one error. The study also revealed the occurrence of pre-analytical errors in phlebotomy practice. These errors included prolonged tourniquet application (26.2%), improper identification (22.9%), inadequate cleaning of the vein puncture site (62.8%), unsafe needle removal and blood transfer to test tubes (6.6%), and improper mixing of collected blood samples (41.5%).Conclusion: The findings of this study revealed a substantial occurrence of pre-analytical errors in the hematology laboratory department. Therefore, it is crucial to prioritize the correct execution and utilization of phlebotomy procedures as well as request format to enhance quality assurance in hematology laboratory units.Keywords: pre-analytical errors, phlebotomy practices, laboratory quality managemen