This is a preprint: it has been shared publicly but has not yet been peer-reviewed.
David Chibuike Ikwuka, Assuman Nuhu, Ibe Michael Usman, Prince Emekor Azanu, Sifikile Songo-Mlilo, Theresa Nkiru Uzor, Moussa Hakizimana, Lawrence Kofi Acheampong, Uzziel Manirareba, Abdullahi Musa Yola, Ophelia Anarfi, Birhanie Muluken Walle, Mayowa Jeremiah Adeniyi, Olufunke Onaadepo, Ejike Daniel Eze, Akaninyene Ubong Ime, Nasiru Sani, VB Archibong, Bisola Folusho Olubiyi, Alphonse Niyodusenga, Hope Onohuean, Diresibachew Haile Wondimu, Abdullateef Isiaka Alagbonsi, Elemi John Ani
Research Square ·
DOI: 10.21203/rs.3.rs-11138233/v1
Abstract
Background Doping threatens athlete health, fair competition, and confidence in sport, yet its prevalence and substance patterns among African athletes remain poorly quantified. Interpretation is complicated by heterogeneous athlete populations, limited representation of elite competitors, and studies that sometimes combine WADA-prohibited agents with permitted supplements, recreational substances, or herbal products. Objective To systematically review and meta-analyze the prevalence of prohibited doping among African athletes, characterize reported substances and methods, compare self-report with laboratory ascertainment, examine regional and competition-level patterns, and identify priorities for surveillance and sports-medicine practice. Methods This PRISMA 2020 systematic review and meta-analysis was prospectively registered in PROSPERO. PubMed/MEDLINE, Scopus, Web of Science, and African Index Medicus were searched without date restriction, supplemented by targeted grey-literature searches. Two independent reviewers screened records, with separate full-text reviewers and third-reviewer adjudication. Outcomes were harmonized against the applicable IOC/WADA framework. Cross-sectional studies were appraised using the JBI prevalence checklist, laboratory surveillance with an adapted JBI case-series framework, and mixed-method grey literature with MMAT. Random-effects meta-analysis used logit-transformed proportions with DerSimonian-Laird estimation and REML/Hartung-Knapp robustness analysis. Results Of 273 records identified, 55 duplicates were removed, 218 records were screened, 44 full texts were assessed, and 19 reports met eligibility criteria. Four independent peer-reviewed cohorts comprising 850 athletes and 64 cases contributed to the primary analysis. The pooled prevalence of ever/previous prohibited doping was 8.0% (95% CI 5.0–12.6%; I²=73.5%). REML/Hartung-Knapp analysis retained the 8.0% estimate with a wider 95% CI of 3.7–16.5%. Pooled anabolic-agent prevalence was 2.3% (95% CI 0.7–7.2%). Two South African laboratory series yielded pooled sample positivity of 3.8% (95% CI 1.2–11.0%; I²=98.0%). Adding the Kenyan WADA/ADAK report increased the pooled self-report estimate to 10.1%. Conclusions Prohibited doping in African sport appears meaningful but remains imprecisely quantified. The pooled estimate should not be interpreted as a continent-wide prevalence value. Elite athletes, sport-specific patterns, and endurance-related agents remain underrepresented. Self-report and laboratory positivity should remain analytically distinct. Standardized WADA-compatible definitions, representative sampling, explicit recall periods, exact numerator/denominator reporting, and stronger biological surveillance are needed. Registration: PROSPERO CRD420261489442.
How to cite
Ikwuka, D. C., Nuhu, A., Usman, I. M., Azanu, P. E., Songo-Mlilo, S., Uzor, T. N., Hakizimana, M., Acheampong, L. K., Manirareba, U., Yola, A. M., Anarfi, O., Walle, B. M., Adeniyi, M. J., Onaadepo, O., Eze, E. D., Ime, A. U., Sani, N., Archibong, V., Olubiyi, B. F., ... Ani, E. J. (2026). Doping Among African Athletes Across Competition Levels: Prevalence, Prohibited Substances, Detection Methods, and Evidence Gaps - A Systematic Review and Meta-analysis. Research Square. https://doi.org/10.21203/rs.3.rs-11138233/v1