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Pediatric brain tumors in sub-Saharan Africa: a systematic review and meta-analysis
Arsene Daniel Nyalundja1,2, Ulrick Sidney Kanmounye2, Claire Karekezi3,4
11Center for Tropical Diseases and Global Health (CTDGH), Catholic University of Bukavu, South Kivu, Democratic Republic of Congo.
Insights
Pediatric brain tumors (PBTs) show varied distribution across sub-Saharan Africa (SSA). Glioma NOS is most common overall, but medulloblastoma is more frequent in Southern SSA, highlighting regional differences in PBT epidemiology.
Area of Science:
- Neuro-oncology
- Pediatric Oncology
- Epidemiology
Background:
- Pediatric brain tumors (PBTs) represent a significant global health challenge, particularly in sub-Saharan Africa (SSA), where their epidemiological landscape is under-researched.
- Understanding the distribution of PBT types is crucial for targeted interventions and improved patient outcomes in the region.
Approach:
- A systematic literature search was conducted across multiple databases (Ovid Medline, Global Index Medicus, African Journals Online, Google Scholar) for studies on PBTs in SSA published before October 29, 2022.
- A proportional meta-analysis was performed on the collected data to analyze the distribution and prevalence of different PBT types.
Key Points:
- Glioma not otherwise specified (NOS) was the most common PBT across SSA, followed by medulloblastoma and craniopharyngioma.
- Medulloblastoma showed a higher prevalence in Southern SSA, while craniopharyngiomas were most common in Western SSA.
- Data from South Africa and Nigeria were most abundant, yet inconsistencies in reporting necessitate further epidemiological studies.
Conclusions:
- This study provides essential insights into PBT trends and proportions across SSA, identifying key areas for policy development and collaborative efforts.
- Addressing data inconsistencies and conducting more robust epidemiological studies are vital for a comprehensive understanding of PBT burden and geographic variations.
- Improved awareness and management strategies for PBTs in SSA are critically needed to enhance patient outcomes.
Objective:
Brain tumors are a global problem, leading to higher cancer-related morbidity and mortality rates in children. Despite the progressive though slow advances in neuro-oncology care, research, and diagnostics in sub-Saharan Africa (SSA), the epidemiological landscape of pediatric brain tumors (PBTs) remains underestimated. This study aimed to systematically analyze the distribution of PBT types in SSA.
Methods:
Ovid Medline, Global Index Medicus, African Journals Online, Google Scholar, and faculty of medicine libraries were searched for literature on PBTs in SSA published before October 29, 2022. A proportional meta-analysis was performed.
Results:
Forty-nine studies, involving 2360 children, met the inclusion criteria for review; only 20 (40.82%) were included in the quantitative analysis. South Africa and Nigeria were the countries with the most abundant data. Glioma not otherwise specified (NOS) was the common PBT in the 4 SSA regions combined. However, medulloblastoma was more commonly reported in Southern SSA (p = 0.01) than in other regions. The prevalence and the overall pooled proportion of the 3 common PBTs was estimated at 46.27% and 0.41 (95% CI 0.32-0.50, 95% prediction interval [PI] 0.11-0.79), 25.34% and 0.18 (95% CI 0.14-0.21, 95% PI 0.06-0.40), and 12.67% and 0.12 (95% CI 0.09-0.15, 95% PI 0.04-0.29) for glioma NOS, medulloblastoma, and craniopharyngioma, respectively. Sample size moderated the estimated proportion of glioma NOS (p = 0.02). The highest proportion of craniopharyngiomas was in Western SSA, and medulloblastoma and glioma NOS in Central SSA.
Conclusions:
These findings provide insight into the trends of PBT types and the proportion of the top 3 most common tumors across SSA. Although statistical conclusions are difficult due to the inconsistency in the data, the study identifies critical areas for policy development and collaborations that can facilitate improved outcomes in PBTs in SSA. More accurate epidemiological studies of these tumors are needed to better understand the burden of the disease and the geographic variation in their distribution, and to raise awareness in their subsequent management.
