Health insurance coverage in sub-Saharan Africa (SSA) remains low and digital premium payment systems have been suggested as a potential solution to increase enrolment and retention. This systematic review will collate and distill empirical evidence on the impact of digital premium payment in scaling health insurance coverage and retention and access to health service delivery in SSA.

This systematic review protocol has been prepared following robust methods, and it is reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will conduct searches through relevant databases, including PubMed, CINAHL, LILACS, HINARI, African Journals Online, Google Scholar, Scopus, Web of Science, Trip Pro and TOXNET from 2007 to 30 June 2026, without language restriction for studies that evaluated digital premium payment systems and reported health insurance enrolment or retention rates. The search terms and concepts include: ‘national health insurance’, ‘health insurance coverage’, ‘insurance enrolment’, ‘digital premium’, ‘e-payment’, ‘online payment’, ‘electronic payment’, ‘mobile payment’, ‘telepayment’ and ‘cashless payment’, together with their alternate terms and synonyms, singular and plural forms as well as British and American spelling. The names of the countries in SSA will be included as search terms. Grey literature including dissertation repositories, national health insurance databases and conference proceedings will be searched. Reference list of retrieved articles will be reviewed, and where necessary, experts working in the field of national health insurance will be contacted for knowledge about completed studies not captured by our searches. Two reviewers will independently screen studies, extract data (using pretested data extraction form developed from Microsoft Excel) and assess risk of bias in the included studies using the quality assessment tool for Risk Of Bias In Non-randomized Studies - of Exposures. Any disagreements will be resolved through discussion between the reviewers. Heterogeneity will be explored graphically for overlapping CIs and statistically using the -statistic. We will combine dichotomous outcomes using risk ratio and for continuous data mean difference employing random-effects meta-analysis and presenting weighted effect estimates with their 95% (CIs). Subgroup analysis will be performed to assess the impact of heterogeneity and sensitivity analyses to test the robustness of the pooled effect estimates. The overall level or certainty of evidence will be assessed using Grading of Recommendations, Assessment, Development, and Evaluation.

This systematic review will collate empirical data on publicly available published and unpublished primary studies and no ethical approval is required. However, an eligible study with serious ethical issues will be excluded from the analysis and the reasons for exclusion documented. The review findings will be shared with key stakeholders and health authorities, agencies involved in digital premium health insurance and policymakers. The review results will be presented at scientific conferences and symposia, and a manuscript will be submitted for publication in a high impact factor journal.

CRD42024576134.

Circumstantial evidence suggests that a high proportion of cases of epilepsy in countries across sub-Saharan Africa (SSA) remain undiagnosed. The magnitude of the burden is unknown. Screening tools offer promise for early detection and prevalence estimation that will enable evidence-informed management of epilepsy in SSA. This review will systematically assess the accuracy and reliability of screening tools for detecting epilepsy in communities and primary care settings in SSA.

Relevant databases, non-database sources and grey literature will be searched for studies on epilepsy screening tools. PubMed, LILACS, CINAHL, PsycINFO and Google Scholar, from inception to 31 May 2026, will be searched for studies on screening tools (questionnaires) administered by non-expert physicians to populations or hospital/clinic-based cohorts with no language restrictions. The following search terms will be used: screening tool, screening questionnaire, screening test, screening instrument, diagnostic tool, diagnostic accuracy, epilepsy, sensitivity, specificity, true positive, false positive, true negative and false negative and SSA. All countries in SSA will be included as search terms. Cochrane databases, African Journals Online, African Index Medicus, HINARI and Preprint and Thesis repositories will also be searched. Reference lists of potentially relevant studies will be reviewed, and experts will be contacted to identify additional studies missed in our searches. Study selection (using a pretested study selection flow chart), data extraction (using a validated data extraction form) and risk-of-bias assessment (using the revised Quality Assessment of Diagnostic Accuracy Studies-2) will be performed independently by at least two reviewers, and any discrepancies will be resolved through discussion. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) will be estimated from 2-by-2 tables of true positives, false positives, true negatives and false negatives. Possible causes of heterogeneity between studies will be assessed through pre-specified subgroup analyses. A meta-analysis will be conducted using a bivariate random-effects model to summarise sensitivity, specificity and DOR per patient. A summary receiver operating characteristic curve will be plotted to determine the overall diagnostic performance of the index tests. Sensitivity analyses will be conducted to test the robustness of pooled estimates of screening accuracy, and all estimates will be presented with their 95% CIs.

This study will synthesise empirical evidence from publicly available published and unpublished studies, and hence no ethical approval is required. An eligible study with serious ethical issues will be excluded from the analysis and the reasons for exclusion will be documented. The review findings will be shared with all relevant stakeholders, including healthcare providers, patient advocate groups, agencies involved in implementing epilepsy care and policies, civil society, social services providers and researchers. The review findings will be shared widely at scientific symposia and conferences, and the final report will be published in a high-impact-factor peer-reviewed journal.

CRD42024566976.