title: Epidemiology, health systems and stakeholders in rheumatic heart disease in Africa: a systematic review protocol.
abstract: Rheumatic heart disease (RHD) is a chronic disease affecting the heart valves, secondary to group A streptococcal infection (GAS) and subsequent acute rheumatic fever (ARF). However, RHD cure and preventative measures are inextricably linked with socioeconomic development, as the disease mainly affects children and young adults living in poverty. In order to address RHD, public health officials and health policymakers require up-to-date knowledge on the epidemiology of GAS, ARF and RHD, as well as the existing enablers and gaps in delivery of evidence-based care for these conditions. We propose to conduct a systematic review to assess the literature comprehensively, synthesising all existing quantitative and qualitative data relating to RHD in Africa.
  
  
  
  We plan to conduct a comprehensive literature search using a number of databases and reference lists of relevant articles published from January 1995 to December 2015. Two evaluators will independently review and extract data from each article. Additionally, we will assess overall study quality and risk of bias, using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Programme criteria for quantitative and qualitative studies, respectively. We will meta-analyse estimates of prevalence, incidence, case fatality and mortality for each of the conditions separately for each country. Qualitative meta-analysis will be conducted for facilitators and barriers in RHD health access. Lastly, we will create a list of key stakeholders. This protocol is registered in the PROSPERO International Prospective Register of systematic reviews, registration number CRD42016032852.
  
  
  
  The information provided by this review will inform and assist relevant stakeholders in identifying key areas of intervention, and designing and implementing evidence-based programmes and policies at the local and regional level. With slight modifications (ie, to the country terms in the search strategy), this protocol can be used as part of a needs assessment in any endemic country.
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Annesinah Hlengiwe
authors.initials: AH
authors.lastname: Moloi
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Department of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: David
authors.initials: D
authors.lastname: Watkins
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Engel
authors.affiliation: Department of Psychiatry, Groote Schuur Hospital Cape Town, Cape Town, South Africa Centre for Evidence Based Health Care, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Sumaya
authors.initials: S
authors.lastname: Mall
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Department of Paediatrics, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
authors.forename: Liesl
authors.initials: L
authors.lastname: Zühlke
mesh_terms: D000349:Africa / Q000453:epidemiology; D006285:Health Planning; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D015201:Meta-Analysis as Topic; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D012107:Research Design; D012213:Rheumatic Fever / Q000453:epidemiology; D012214:Rheumatic Heart Disease / Q000453:epidemiology* / Q000401:mortality; D000073597:Stakeholder Participation; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013297:Streptococcus pyogenes; D000078202:Systematic Reviews as Topic
keywords: Acute Rheumatic fever,; Africa; Group A Streptococcus; Health systems; Rheumatic heart disease; stakeholders