Article Text
PDF
Abstract
Introduction Infertility adversely affects the sexual reproductive health and overall quality of life of people. Recent estimates show that about one in six people (both men and women) experience infertility in their lifetime. This scoping review will, therefore, map the existing evidence on traditional management of female infertility in Africa including the effectiveness of the traditional healthcare systems, to inform policy and practice.
Methods The scoping review will be guided by the Arksey and O’Malley framework in conjunction with the Joanna Briggs Institute updated methodological guidance for scoping reviews. A search strategy will be developed, which will target the following databases: PubMed, Scopus, Embase, CINAHL, Google Scholar and Africa-Wide Information including grey literature. The screening of titles, abstracts and full text will be done by two independent reviewers. Data will be extracted, analysed numerically and thematically. The reporting of the scoping review will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist.
Ethics and dissemination This scoping review will not require ethical approval as this is secondary analysis of peer-reviewed articles. The findings of the review will be disseminated on various platforms including conferences, meetings to key stakeholders and in a peer-reviewed journal for wider sharing.
- complementary medicine
- subfertility
- herbal medicine
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
STRENGTHS AND LIMITATIONS OF THIS STUDY
This review protocol describes a rigorous search strategy and methodological framework for summarising the evidence that is available for the traditional management of female infertility in Africa.
The search strategy will be inclusive of peer-reviewed literature from six medical and social science databases and grey literature.
The reporting of the scoping review will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, thus ensuring a rigorous approach.
The limitations of the proposed review will be the exclusion of non-English studies and exclusion of studies with service providers who are not traditional health practitioners.
Introduction
Infertility is a major reproductive health concern. Infertility is defined as ‘a disease characterised by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with his/her partner’.1 Infertility can be primary or secondary, with the primary being ‘never had a clinical pregnancy after 12 months of regular, unprotected sexual intercourse’, and secondary being ‘not having a clinical pregnancy but had previously been diagnosed with a clinical pregnancy’.1 Global estimates between 1990 and 2021 indicate that about one in six people experience infertility in their lifetime.2 3 Infertility is reported to be high in South Asia, sub-Saharan Africa, North Africa/Middle East and Central/Eastern Europe and Central Asia.4 A meta-analysis of infertility in Africa conducted in 2020 reported that the pooled proportion of primary infertility in Africa was 49.91%, with 70.56% in North Africa, 41.57% in West Africa, 40% in Southern Africa and 30.37% in East Africa.5 The same meta-analysis reported pooled proportion of secondary infertility in Africa of 49.79%, with 29.58% in North Africa, 57.64% in West Africa, 60% in Southern Africa and 69.63% in East Africa.5 This scoping review will consider both primary and secondary infertility.
Traditional health management systems have been in existence since time immemorial.6 The increase in economic meltdown in most African countries and the high costs of allopathic medical care has resulted in more people seeking traditional healthcare systems.7 8 Use of traditional medicine (TM) in treatment of infertility is common in Africa.9 10 Lu et al report that between 70% and 95% of the population in developing countries use TM.11
Previous review studies have been conducted on the traditional management of infertility, showing the growth of research in the area. These include a review done by Carson and Kallen on the diagnosis and management of infertility with a focus on clinical diagnosis and management.12 Vatsa and Sethi in their scoping review focused on the impact of endometriosis on female fertility and the management options for endometriosis-related infertility in reproductive age women.13 Lee et al review was on the effects of acupuncture and herbal medicine on female infertility.14 Another review by Akbaribazm et al on the effects of plants on female infertility showed that there are some plants which are used to treat female reproductive disorders such as polycystic ovary syndrome, premature ovarian failure, endometriosis, hyperprolactinaemia and hypothalamic dysfunction.15 A systematic review on the holistic management of female infertility conducted by Armah et al, showed that interventions used in managing infertile women included: ‘counselling; cognitive behavioural therapy; acceptance and commitment therapy; educational interventions; spiritual interventions; emotionally focused therapy/intervention and integrative body-mind-spirit interventions’.16 Most of these reviews cite studies that have been done in non-African countries and they have tended to be biased towards specific research designs such as randomised controlled trials, quantitative, observational studies and meta-analyses. These reviews have limited African evidence where use of traditional healthcare systems is high. Therefore, it is critical to conduct a scoping review focusing on studies conducted in Africa to explore the breadth and depth of evidence available in the management of female infertility in African traditional healthcare systems.
A scoping review approach has been chosen as it will provide a broader scope on the existing evidence in the traditional management of female infertility.17 It will give clarity on how traditional health practitioners (THPs) conceive female infertility and its management. Findings from the review will contribute to better understanding of traditional constructs of and infertility management of female infertility as well as to inform policy and practice.
Methods
The scoping review will be guided by the Arksey and O’Malley scoping review framework18 in conjunction with Joanna Briggs Institute (JBI) updated methodological guidance for the conduct of scoping reviews.19 20 The Arksey and O’Malley framework is based on the proponent to ensure that the steps of the scoping review process provide sufficient details for replication of the review.18 This ultimately increases reliability of the results of the review. The framework has the following five stages which will be followed.
Stage 1: identifying the research question.
Stage 2: identifying relevant studies.
Stage 3: study selection.
Stage 4: charting the data.
Stage 5: collating, summarising and reporting the results.
Stage 6: consultation exercise.
These six stages are expanded below:
Stage 1: identifying the research question
The main aim of the scoping review is to systematically map the evidence on traditional management of female infertility in Africa and to identify possible knowledge gaps. The primary research question is ‘What is the available evidence of traditional management of female infertility in Africa?’. Further questions which will be answered are as follows.
How do THPs define female infertility?
What are the treatment options available for infertile women in traditional healthcare systems in Africa?
What evidence is there on the effectiveness of traditional management of female infertility in Africa?
What are the experiences of infertile women who have sought traditional healthcare systems?
Objectives
The main objective of this scoping review is to systematically map the evidence on traditional management of female infertility in Africa. Specifically, the review intends to:
Find out how THPs define female infertility.
Identify existing research on the treatment options that are available for treating women in traditional healthcare systems in Africa.
Identify the available evidence showing effectiveness of traditional management of female infertility in Africa.
Describe the experiences of women who sought traditional healthcare systems.
Identify possible knowledge gaps in traditional management of female infertility.
Stage 2: identifying relevant studies
The researcher (TM) in collaboration with a librarian (MM) will search databases to retrieve relevant studies in peer-reviewed journals. Only English studies will be considered and there will not be restriction of time frame as older studies could be relevant to the area of study. All studies will be considered regardless of their study design, thus quantitative, qualitative and mixed-methods articles as well as systematic reviews will be considered. This will allow the reviewers (TM and MM) to explore the breadth and depth of the area of review. Selection of the final articles will be done by the researcher and the librarian to add rigour.19 The reviewers developed the eligibility criteria (inclusion and exclusion criteria) as well as agreed on the databases that will be searched. Table 1 highlights the preliminary inclusion and exclusion criteria for articles that will be accepted.
Inclusion and exclusion criteria for acceptable articles
Selection criteria
Both TM and MM will produce a Medical Subject Headings search string that will be used to guide the information retrieval. They will engage key informants in the infertility field for guidance in searching from grey literature and unpublished documents. They will also use a search strategy based on Population, Concept and Context as stipulated by the JBI updated scoping review guidelines since the Arksey and O’Malley framework is silent on the selection criteria.18 The JBI methodology provides an updated methodology guidance for conducting scoping reviews.19 The search strategy will include application of truncation and wild cards to keywords to broaden results from the databases that will be targeted. Table 2 highlights the search strategy that will be used.
Search strategy keywords
Search databases
The databases that will be searched include PubMed, Scopus, Embase, CINAHL, Google Scholar and Africa-Wide Information. Sources of unpublished studies/grey literature that will be searched include university dissertations repositories, discussion forums, conference papers, guidelines and programmatic reports from WHO, United Nations Population Fund or infertility associations and clubs such as the African Federation of Fertility Societies, Infertility Awareness Association of South Africa. The reviewers will also consider infertility associations based in Zimbabwe such as Chido Chedu Trust, Hannah’s Tears and Mummy’s clubs and they will critically appraise any grey literature that may arise from these to assess reliability of literature.
Stage 3: study selection
The selection criteria will be discussed and agreed on by the reviewers. The reviewers will deduplicate first before screening. They will first consider the titles and abstracts retrieved independently and check for relevance to be included in the review. During the screening process, articles not meeting the inclusion criteria will be excluded. The reviewers will use Microsoft Excel sheets for the screening purpose. The spread sheets will have the following headings:
Article identification number.
Title.
Abstract.
Year.
Journal.
URL.
Document object identifier.
Country.
Region.
Traditional management practice.
Target population.
Decision, that is, yes, no or maybe. The article that will be classified as ‘maybe’, is an article that does not provide clearly all the elements of the eligibility criteria at title and abstract level.
A meeting will be held by the reviewers to discuss their independent Excel spreadsheets and to agree on the list of articles for full text screening. In case of disagreements, a third member will be engaged for further assessment. Having agreed on the list of articles for partial inclusion, the reviewers will then screen the full text articles to determine the final articles for data extraction.
Stage 4: charting the data
Data will be extracted by two reviewers from the articles that meet the final inclusion list using a data extraction tool that will be developed. The key information that will be extracted which will form the key sections of the data or charting extraction tool which will include the following:
Author(s).
Year of publication.
Origin/country of origin (where the study was published or conducted).
Aims/purpose.
Population and sample size (if applicable).
Methodology/methods.
Intervention type/duration, comparator.
Outcome measures (if applicable).
Key findings that relate to the scoping review question/s.
Modifications on the data or charting extraction tool will be done during the extraction process if the need arises to comprehensively answer the review questions. These will be detailed in the scoping review article. As recommended by the Arksey and O’Malley framework, the reviewers will use Microsoft Excel spreadsheet to chart each paper.18
Stage 5: collating, summarising and reporting the results
In this stage, the descriptive information from the findings will be presented. The retrieved articles will initially undergo critical appraisal using JBI critical appraisal tools to assess the quality of the articles.21 This will ensure that the disseminated results will be useful for policy-makers and practice as well as inform future research in the traditional management of infertility field. Synthesis of the results will be done for articles appraised through summarising the charting results in relation to the review questions. According to Arksey and O’Malley the narrative should be presented in two ways; numerically and thematically.18 Quantitative analysis will be conducted using descriptive methods and data will be presented as a summary of statistics in the form of tables, charts and maps to highlight the traditional treatment options used in women, the study designs and geographical representation among others. Thematic analysis will be carried out in three ways (a) coding of the text (b) descriptive themes (c) analytical themes. The reviewers will meet and discuss the themes that will arise as well as interpretation of the themes to minimise bias of the findings. In addition, they will identify and report on the gaps in the field of traditional management of infertility as well as come up with recommendations for policy and practice. The reporting of the review will be done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist and explanation.22
Stage 6: consultation exercise
Although, Arksey and O’Malley scoping review framework considers this stage as optional,18 the reviewers will consult stakeholders in particular TM and infertility experts in Zimbabwe. These will input on the search strategy and grey literature as well as validate the review results.
Patient and public involvement
There will be no patient and public involvement in the study. However, findings of the scoping review will be shared with relevant key stakeholders.
Ethics and dissemination
The scoping review will not involve any data collection from participants thus this will not require ethical approval. The findings of the review will be published in a peer-reviewed journal that focuses of infertility and TM. Findings will also be shared in conferences and platforms that target researchers, service providers and policy-makers and this will provide information on the literature available on traditional management of female infertility as well as highlight gaps for future research in the area.
Implications
This review has the potential to improve understanding and utilisation of traditional healthcare systems in the treatment of female infertility. This will be accomplished by identifying current research gaps based on available evidence. As a result, future research will be guided, and strategies, policies and interventions to improve the management of female infertility in traditional healthcare systems will be developed. It can also bridge the gap between traditional and modern medical approaches, allowing for more holistic patient care interventions.
Ethics statements
Patient consent for publication
Footnotes
Twitter @mmuziringa, @Mugogynae
Contributors All authors have made substantive intellectual contributions to the development of this protocol. TM, JJ and EG conceptualised the review approach, developed the review question, review design and search strategy. MM, JC-M and MGM gave substantial review and critique to the draft of the protocol.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.