State of high-grade glioma care in Africa: insights from a scoping review of the available published literature

Vollständiger Abstract

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Background High-grade gliomas (HGGs), WHO grade 3–4 diffuse gliomas, are aggressive primary brain tumors. Evidence on their management and outcomes in Africa remains limited, unevenly distributed, and lacking population-based incidence data. This review mapped published literature on HGG epidemiology, clinical presentation, diagnosis, treatment, and outcomes across represented African countries. Methods This review followed the Arksey and O’Malley framework, refined by Levac et al. and the Joanna Briggs Institute, and reported per PRISMA-ScR guidelines, with the protocol prospectively registered on OSF (osf.io/hkf6g). Six databases were searched (inception-January 2026) for studies of African patients with confirmed WHO grade 3–4 gliomas; quality was appraised by two reviewers using JBI tools. Data were synthesized descriptively and stratified by study design, with no meta-analytic pooling. Results Twenty-five studies (2008-2025) reporting 1,212 patients from 11 of 54 African countries were included; 312 (25.7%) were excluded as non-HGG or unconfirmed, leaving 900 in the confirmed cohort. Most studies were retrospective (56%), concentrated in Morocco (36%), Nigeria, and Côte d’Ivoire (16% each); 20% were case reports or small series. Raised intracranial pressure, motor deficits, and seizures showed mean study-level frequencies of 62%, 61%, and 41% (in 14, 12, and 11 of 25 studies). MRI was reported in 80% of studies; advanced imaging was rarely available. Glioblastoma predominated (833/900, 92.6%), and molecular testing (IDH, MGMT) was inconsistent. Gross total resection was achieved in a minority of patients; no study reported intraoperative adjuncts (neuronavigation, fluorescence guidance). Mortality at last follow-up ranged from 16.1%-100% (upper value from a single four-patient case series). Median overall survival ranged from 11–14 months, closely approximating median follow-up (11.7 months); these figures should be interpreted as descriptive rather than statistically estimated survival. Conclusion Within evidence from 11 of 54 African countries, HGG care shows major diagnostic and therapeutic disparities and regional inequalities; findings should not be generalized continent-wide. Investment in infrastructure, training, molecular diagnostics, funding, and regional collaboration is needed to improve outcomes, equity of care, and evidence representativeness.