Predictors of long-term outcome of patients with schizophrenia in Africa: systematic review and meta-analysis

BackgroundOne of the most compelling areas of schizophrenia research involves the investigation of its longitudinal course and clinical outcomes. Longitudinal studies have provided profound insights into the trajectory of schizophrenia, elucidating its progression, clinical phenotype, functional impairments, treatment responsiveness, and key prognostic determinants. While contemporary therapeutic interventions have demonstrated promise in altering disease trajectory and enhancing recovery, schizophrenia remains characterized by heterogeneous outcomes, distinguishing it from other psychotic disorders. This review aims to assess the pooled prevalence of positive outcomes and identify key predictors on individuals with schizophrenia disorder across Africa.MethodsA comprehensive systematic search was conducted across multiple databases, including PubMed/MEDLINE, Scopus, African Journal Online, PsycINFO, EMBASE, Psychiatry Online, CINAHL, Science Direct, and the Cochrane Library. This review includes observational studies, comprising both cross-sectional and cohort designs, published between 1993 and 2024, that evaluate the prognosis and favorable clinical outcomes of schizophrenia in Africa. The literature search was performed between November 2, 2024, and December 20, 2024. A total of sixteen original research articles assessing the prevalence of favorable outcomes in individuals with schizophrenia met the inclusion criteria. Data extraction was conducted independently by two reviewers to ensure methodological rigor, and the review is registered with PROSPERO (ID: CRD42024613692).ResultsThe pooled prevalence of positive outcomes among individuals with schizophrenia disorder in Africa was estimated at 44.17% (95% CI: 32.27-56.08). Among a total of 2,263 individuals, the aggregated remission rate across 13 studies was 48.14%, while the pooled recovery rate was 42% among 474 individuals across 4 studies. Furthermore, significant predictors of positive outcomes included the presence of prominent positive symptoms (OR = 1.89, 95% CI: 1.24-2.89), prolonged antipsychotic use (OR = 2.15, 95% CI: 1.69-2.74), and good medication adherence (OR = 4.31, 95% CI: 2.17-8.56).ConclusionThis review reveals that nearly half of individuals with schizophrenia in Africa achieve favorable outcomes, despite ongoing challenges. Key predictors-prominent positive symptoms, prolonged antipsychotic use, and good medication adherence-significantly influence prognosis. These findings underscore the need for early, personalized interventions and sustained treatment adherence. Given the heterogeneity of outcomes, region-specific strategies are essential to optimize care.