Measuring health-related quality of life in Africa: a systematic review of validated disease-specific and generic measurement tools.

Background: This systematic review examines the evidence on the use of health-related quality of life (HRQoL) tools for African populations and evaluates their psychometric properties, cultural adaptation, and applicability. Methods: A systematic search was conducted across PubMed, Web of Science, Scopus, and gray literature from January 2015 to January 2025. The review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) frameworks. Duplicate screening and study selection were independently performed by multiple reviewers. Eligible studies included the development, adaptation, or validation of HRQoL for African populations. The protocol was submitted for registration to the International Prospective Register of Systematic Reviews (PROSPERO) under the identification number CRD42025639055. Results: Forty studies met the inclusion criteria, with 31 (77.5%) focusing on adults and minimal attention given to the pediatric population. East Africa had the highest representation, with 17 (42.5%), while West Africa accounted for 7 (17.5%). Internal consistency (Cronbach's alpha ≥ 0.70) was demonstrated in 33 (97.1%) out of the 34 tools. A total of 34 different HRQoL tools were identified, including 12 generic instruments. The SF-12 and WHOQOL-BREF were the most validated tools, whereas the EORTC QLQ-C30 was the most validated disease-specific tool. Cultural adaptation was a major focus, with 32 (80.0%) of the studies incorporating linguistic modifications to enhance contextual relevance. Most studies, 28 (70.0%), used cross-sectional designs. Overall, most tools demonstrated good reliability and cultural adaptability, although limitations such as small sample sizes, limited geographic coverage, and incomplete reporting of responsiveness and test-retest reliability were common. Conclusion: Significant progress has been made in developing and validating HRQoL tools for African populations. However, gaps remain, including the need for longitudinal studies, greater inclusion of children's HRQoL assessments, and broader geographic representation. Strengthening research capacity will be pivotal in advancing culturally responsive HRQoL tools and integrating them into healthcare decision-making in Africa. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025639055, Identifier: CRD42025639055.