Meta-analysis, a statistical combination of results of several trials to produce a summary effect, has been subject to criticism in the past, mainly for the reasons of poor quality of included studies, heterogeneity between studies meta-analyzed and failing to address publication bias. These limitations can cause the results to be misleading, which is important if policy and practice decisions are based on systematic reviews and meta-analyses. We elaborate on these limitations and illustrate them with examples from the nephrology literature. Finally, we present some potential solutions, notably, education in meta-analysis for evidence producers and consumers as well as the use of individual patient data for meta-analyses.

Increased antiretroviral therapy uptake in sub-Saharan Africa has resulted in improved survival of the infected. Opportunistic infections are declining as leading causes of morbidity and mortality. Though comprehensive data are lacking, concern has been raised about the rapid emergence of non-communicable diseases (NCDs) in the African HIV care setting. We therefore set out to characterise the NCD/HIV burden among adults living and ageing with HIV infection in Zimbabwe. We conducted a cross-sectional study among patients receiving care in a public sector facility. We reviewed patient records and determined the prevalence of comorbid and multi-morbid NCDs. Associations with patient characteristics were evaluated using univariate and multi-variate logistic regression modelling. Significance testing was done using 2-sided p values and 95 % confidence intervals calculated. We recruited 1033 participants. 31 % were men. Significant gender differences included: older median age, more advanced disease at baseline, and greater use of stavudine and protease inhibitor containing regimens in men compared to women. The prevalence of comorbidity and multi-morbidity were, respectively, 15.3 % (95 % CI 13.3–17.7 %) and 4.5 % (95 % CI 3.4–6.0 %). Women had higher rates than men of both co-morbidity and multi-morbid ity: 21.8 vs. 14.9 %; p = 0.010 and 5.3 vs. 2.9 %; p = 0.025 respectively. The commonly observed individual NCDs were hypertension [10.2 %; (95 % CI 8.4–12.2 %)], asthma [4.3 % (95 % CI 3.1–5.8 %)], type 2 diabetes mellitus [2.1 % (95 % CI 1.3–3.2 %)], cancer [1.8 % (95 % CI 1.1–2.8 %)], and congestive cardiac failure [1.5 % (95 % CI 0.9–2.5 %)]. After adjusting for confounding, only age categories 45–≤55 years (AOR 2.25; 95 % CI 1.37–3.69) and >55 years (AOR 5.42; 95 % CI 3.17–9.26), and female gender (AOR 2.12; 95 % CI 1.45–3.11) remained significantly and strongly associated with comorbidity risk. We found a substantial burden of comorbid non-communicable diseases among HIV infected patients in a high HIV and low-income setting. Integrating non-communicable diseases care, including active screening, with HIV care is recommended.

Background: Analysis of hospital-acquired bloodstream infection (HA-BSI) trends is important to monitor emerging antimicrobial resistance (AMR) threats and guide empiric antibiotic choices. Methods: A retrospective 10-year review of neonatal HA-BSI was performed at Tygerberg Hospital’s neonatal unit in Cape Town, South Africa. Neonatal clinical and laboratory data from 2014 to 2018 (Period 2) was compared with published data from 2009 to 2013 (Period 1). Results: The neonatal unit’s HA-BSI rate declined between periods from 3.9/1000 inpatient-days in Period 1 to 3.3/1000 inpatient-days in Period 2 (p = 0.002). Pathogen yield and blood culture contamination rate were unchanged (11.0% to 10.4%, p = 0.233; 5.1% to 5.3%, p = 0.636 respectively). Gram-negative pathogens predominated (1047/1636; 64.0%); Klebsiella species, Staphylococcus aureus, Serratia marcescens, Enterococcus species and Acinetobacter baumannii were the most frequent pathogens. Extended spectrum beta-lactamase production was observed in 319/432 (73.8%) of Klebsiella species, methicillin resistance in 171/246 (69.5%) of Staphylococcus aureus and extensive drug resistance in 115/137 (83.9%) of Acinetobacter species (2009–2018). The crude mortality rate of neonatal HA-BSI episodes increased from Period 1 to Period 2 from 139/717 (19.4%) to 179/718 (24.9%) (p = 0.014), but HA-BSI attributable mortality remained unchanged (97/139 [69.8%] vs 118/179 [65.9%], p = 0.542). The in-vitro activity of piperacillin-tazobactam and amikacin declined during Period 2 (74.6% to 61.4%; p<0.001). Conclusion: Although HA-BSI rates declined in the neonatal unit, antimicrobial resistance rates in BSI pathogens remained high. Continuous BSI surveillance is a valuable tool to detect changes in pathogen and AMR profiles and inform empiric antibiotic recommendations for neonatal units in resource-limited settings.

The development of research capacity among undergraduates is an important intervention in countering the documented decrease in medical and health sciences researchers. The literature on undergraduate research generally emanates from smaller scale studies that have been conducted in high income countries, with a focus on medical students. This cross-sectional study was conducted in a Sub-Saharan country, included a population of medical and allied health professions (AHP) students, and aimed to improve our understanding of the factors influencing undergraduate student research. A questionnaire was distributed to all students enrolled in an undergraduate programme at the Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa (including Medicine and four AHP programmes). Data was collected on a number of demographic characteristics and on 3 major outcome-themes: “voluntary research involvement”, “self-perceived research competence” and “future research participation”. Associations between characteristics and outcome themes were explored. In total, 1815 students participated in the study (response rate 80.2%). Of all the demographic variables, discipline (AHP programmes vs. Medicine), male gender and prior undergraduate experience in a science degree were significantly associated with voluntary research involvement. Significantly higher levels of self-perceived research competence and greater interest in future research participation, were seen among participants from AHP programmes; males; and those with previous or current voluntary research involvement. Ethnicity and geographic background were not significantly associated with any of our outcomes. Our results offer important new evidence in support of the imperative to diversify the research work-force, in Sub-Saharan Africa and globally. Enhanced efforts aimed at achieving better academic representation in terms of gender, ethnicity, geographical and socio-economic backgrounds are strengthened by the findings of this study. Potential student researchers represent an important group amenable to further intervention. Further research may be required to explore the factors that determine the progression from interest to future participation in research.

The data ecosystem is complex and involves multiple stakeholders. Researchers and scientists engaging in data-intensive research collect, analyse, store, manage and share large volumes of data. Consequently, capturing researchers’ and scientists’ views from multidisciplinary fields on data use, sharing and governance adds an important African perspective to emerging debates. We conducted a descriptive cross-sectional survey and received 160 responses from researchers and scientists representing 43 sub-Saharan African countries. Whilst most respondents were satisfied with institutional data storage processes, 40% indicated that their organisations or institutions did not have a formally established process for storing data beyond the life cycle of the project. Willingness to share data was generally high, but increased when data privacy was ensured. Robust governance frameworks increased the willingness to share, as did the regulation of access to data on shared platforms. Incentivising data sharing remains controversial. Respondents were satisfied with exchanging their data for co-authorship on publications (89.4%) and collaboration on projects (77.6%). However, respondents were split almost equally in terms of sharing their data for commercial gain. Regarding the process of managing data, 40.6% indicated that their organisations do not provide training on best practices for data management. This could be related to a lack of resources, chronic institutional under-investment, and suboptimal research training and mentorship in sub-Saharan Africa. The sustainability of data sharing may require ethical incentive structures to further encourage researchers and scientists. Tangible infrastructure to facilitate such sharing is a prerequisite. Capacity development in data governance for researchers and scientists is sorely needed. Significance: Data sharing is necessary to advance science, yet there are many constraints. In this study, we explored factors that promote a willingness to share, as well as constraining factors. Seeking potential solutions to improve data sharing is a scientific and ethical imperative. The standardisation of basic data sharing and data transfer agreements, and the development of a Data Access Committee will strengthen data governance and facilitate responsible data sharing in sub-Saharan Africa. Funders, institutions, researchers and scientists ought to jointly contribute to fair and equitable data use and sharing during and beyond the life cycle of research projects.

Background: South Africa has experienced a substantial increase in access to antiretroviral treatment (ART) in recent years. Effective strategies to manage access to treatment need to be incorporated into and implemented in ART programmes. Antiretroviral treatment adherence clubs are a new strategy that is being implemented in various parts of South Africa. Aim: The aim of the study was to investigate treatment adherence and patient satisfaction of stable human immunodeficiency virus (HIV) patients on ART in ART adherence clubs and clinics. Setting: The study was conducted in the Eden district of the Western Cape, South Africa. Methods: A cross-sectional analytical study was conducted to examine the relationships between patient satisfaction and treatment adherence in ART adherence clubs and clinics in the Eden district, Western Cape province, South Africa. Validated questionnaires were used to measure patient satisfaction and self-reported treatment adherence. Results: The study included 320 participants (98 club and 222 clinic) from 13 primary health care clinics. The analyses showed that higher levels of satisfaction could be predicted with club participants compared to clinic participants (p = 0.05). There was no significant difference between clinic and club participants with regards to treatment adherence. However, being adherent was more likely in participants who were satisfied (odds ratio = 3.18, 95% confidence interval [1.14–7.11], p < 0.01). Conclusion: Antiretroviral treatment adherence clubs provide a service that patients are more satisfied with although they are not more adherent to treatment. This strategy may be effective for the delivery of long-term care for patients on ART.