ABSTRACT
Aim To summarise and describe the burden of serious adverse drug
reactions (ADRs) in sub-Saharan Africa (SSA) in the era of
antiretroviral therapy.
Methods We searched Medline, CINAHL, Africa-Wide Information,
Scopus, and Web of Science, without language restriction up to March
2021. We hand-searched reference lists, conference abstracts, and
dissertation databases. We included studies reporting proportions of
admissions attributed to ADRs, admissions prolonged by ADRs, or
in-hospital deaths attributed to ADRs. Two reviewers independently
screened studies, reviewed study quality using a previously published
tool, and extracted data. We tested for heterogeneity using
I2-statistics and summarised study results using
medians and interquartile ranges. Subgroup analyses summarised results
by study quality, setting, methodology, and population.
Results From 1005 unique references identified, we included 15
studies. Median study quality was 7/10; heterogeneity was very high.
Median [IQR] proportion of admissions attributed to ADRs was 4.8%
[1.5% to 7.0%] (14 studies), and 6.4% [4.0% to 8.4%] in
nine active surveillance studies in adults. Two paediatric studies
reported the proportion of admissions prolonged by ADRs (0.29% and
0.99%). Three studies reported the proportion of in-hospital deaths
attributed to ADRs (2.5%, 13%, and 16%). Antiretroviral and
antituberculosis drugs were often implicated in serious ADRs.
Conclusion Evidence of the burden of serious ADRs in SSA is
patchy and heterogeneous. A few high-quality studies suggest the burden
is considerable, and that it reflects the regional impact of the HIV
pandemic. Further characterisation of this burden is required, ideally
in studies of standardised methodology.