Multiple Sclerosis Research Across the African Continent: A Systematic Review
Soonmyung Hwang1, Ilena George2, Maria A. Garcia-Dominguez3, Vanessa Salasky4, Anastasia Vishnevetsky5, Dhanashri Miskin6, Andy Tran7, Brian Chiluba8, Deanna Saylor9
1Icahn School of Medicine at Mount Sinai, 2Massachusetts General Hospital, 3Johns Hopkins Bloomberg School of Public Health, 4University of Maryland, 5Massachusetts General Hospital, Brigham, Harvard, 6Thomas Jefferson University, 7University of Iowa Carver College of Medicine, 8University of Zambia, 9Johns Hopkins Hospital
Objective:
To summarize the contemporary state of MS research across the African continent and to identify knowledge gaps from the current research landscape.
Background:
MS remains considered a rare neurological disorder among African populations, despite the fact that original MS research based in African countries is extremely limited or non-existent.
Design/Methods:
Boolean searches on the PubMed, SCOPUS and Embase databases were conducted for articles published from 1990 to February 2022. Two reviewers evaluated the title and abstract of each identified record for inclusion based on pre-defined eligibility criteria. Discrepancies between reviewers were resolved by discussion until consensus was reached. Full-text review and data extraction were conducted by a single reviewer for all articles which passed the initial title and abstract screening process.
Results:
After removal of duplicates, 2491 records were initially identified and underwent screening. 332 records were then selected for full-text review and 251 were deemed eligible for inclusion. The majority of included studies were from the Northern African region (n=204; 81%), particularly from Egypt (n=166; 66%), and had a case-control study design (n=145; 58%). Studies based in Egypt, Tunisia and South Africa accounted for >90% of included studies. Over 50% (n=150) of selected studies were published from 2016-2022, highlighting the substantial increase in research output in recent years. Studies investigating the utility of diagnostic tools (i.e. blood/serum biomarkers and neuroimaging technology) were most common (n=105; 42%), followed by studies investigating MS risk factors (n=41; 16%).
Conclusions:
The majority of MS research from the African continent comes from only a few countries with virtually no data from the majority of African countries. Notable gaps and barriers in our knowledge of the burden of MS in Africa remain, and further efforts to promote clinical and epidemiological MS research in sub-Saharan Africa are needed to improve our understanding of the burden of MS amongst African patients.