Treatment for Depression in Low-Income Women: A Systematic Review and Meta-Analysis

ObjectiveCompare paediatric COVID-19 disease characteristics, management and outcomes according to World Bank country income level and disease severity.DesignSystematic review and meta-analysis.SettingBetween 1 December 2019 and 8 January 2021, 3350 articles were identified. Two reviewers conducted study screening, data abstraction and quality assessment independently and in duplicate. Observational studies describing laboratory-confirmed paediatric (0–19 years old) COVID-19 were considered for inclusion.Main outcomes and measuresThe pooled proportions of clinical findings, treatment and outcomes were compared according to World Bank country income level and reported disease severity.Results129 studies were included from 31 countries comprising 10 251 children of which 57.4% were hospitalised. Mean age was 7.0 years (SD 3.6), and 27.1% had a comorbidity. Fever (63.3%) and cough (33.7%) were common. Of 3670 cases, 44.1% had radiographic abnormalities. The majority of cases recovered (88.9%); however, 96 hospitalised children died. Compared with high-income countries, in low-income and middle-income countries, a lower proportion of cases were admitted to intensive care units (ICUs) (9.9% vs 26.0%) yet pooled proportion of deaths among hospitalised children was higher (relative risk 2.14, 95% CI 1.43 to 3.20). Children with severe disease received antimicrobials, inotropes and anti-inflammatory agents more frequently than those with non-severe disease. Subgroup analyses showed that a higher proportion of children with multisystem inflammatory syndrome (MIS-C) were admitted to ICU (47.1% vs 22.9%) and a higher proportion of hospitalised children with MIS-C died (4.8% vs 3.6%) compared with the overall sample.ConclusionPaediatric COVID-19 has a favourable prognosis. Further severe disease characterisation in children is needed globally.

Download Full-text

Sugar Sweetened Beverages Intake and Risk of Non-Communicable Chronic Diseases in Longitudinal Studies: A Systematic Review and Meta-Analysis with 1.5 Million Individuals

10.21203/rs.3.rs-950662/v1 ◽

2021 ◽

Author(s):

Leonardo Pozza Santos ◽

Denise Petrucci Gigante ◽

Felipe Mendes Delpino ◽

Ana Paula Maciel ◽

Renata Moraes Bielemann

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Coronary Heart Disease ◽

Heart Disease ◽

Longitudinal Studies ◽

Low Income ◽

Meta Analysis ◽

Sugar Sweetened Beverages ◽

Sweetened Beverages

Abstract This study aimed to examine longitudinal associations between sugar-sweetened beverages (SSB) intake and type 2 diabetes, obesity, coronary heart disease and stroke in adults. We performed a systematic review and meta-analysis searching for articles in the Pubmed, Lilacs, Web of Science, Cochrane, Embase, and Scopus databases. After screening of titles and abstracts, 27 longitudinal studies were included for the narrative synthesis with all of them presenting medium or high methodological quality. None of the selected studies were from low-income countries and only three were conducted in middle-income countries. Type 2 diabetes was the most investigated disease – outcome in 15 out of 27 studies. Around 80% of the studies enrolled more than 10,000 individuals in the sample, and almost half of them followed the subjects for less than 10 years. A total of 1.5 million individuals were included in the pooled analyses, and results indicated that SSB intake increased the risk of type 2 diabetes (RR = 1.20; 95%C.I. 1.13 – 1.28), obesity (RR = 1.17; 95%C.I. 1.10 – 1.25), coronary heart disease (RR = 1.15; 95%C.I. 1.06 – 1.25), and stroke (RR = 1.10; 95%C.I. 1.01 – 1.19) in adults after adjustment for all potential confounders. Our systematic review and meta-analysis demonstrated that consumption of SSB intake appears to increase the risk non-communicable chronic disease, being the strongest evidence for type 2 diabetes. Actions are needed to be taken to reduce the SSB intake and its consequences worldwide.

Download Full-text

Clinical effectiveness of drugs in hospitalized patients with COVID-19 infection: a systematic review and meta-analysis.

10.1101/2020.09.11.20193011 ◽

2020 ◽

Author(s):

Roberto Ariel Abeldano Zuniga ◽

Silvia Coca ◽

Giuliana Abeldano ◽

Ruth Ana Maria Gonzalez Villoria

Keyword(s):

Systematic Review ◽

Clinical Improvement ◽

Low Income ◽

Randomized Clinical Trials ◽

Data Extraction ◽

Meta Analysis ◽

Clinical Effectiveness ◽

Hospitalized Patients ◽

Low Income Countries ◽

Qualitative Synthesis

Objective. The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection. Method. We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization), virological clearance, and severe adverse events. Results. A total of 48 studies were retrieved from the databases. Ten articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir. Conclusions. Dexamethasone would have a better result in hospitalized patients, especially in low-resources settings. Significance of results. The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries; since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources. Keywords: Drugs; Antivirals; Clinical improvement; Mortality; COVID-19; SARS-CoV2.

Download Full-text

Task-sharing interventions for improving control of diabetes in low-income and middle-income countries: a systematic review and meta-analysis

The Lancet Global Health ◽

10.1016/s2214-109x(20)30449-6 ◽

2020 ◽

Author(s):

Joseph Linju Maria ◽

T N Anand ◽

Boban Dona ◽

Jose Prinu ◽

Dorairaj Prabhakaran ◽

...

Keyword(s):

Systematic Review ◽

Low Income ◽

Meta Analysis ◽

Task Sharing ◽

Middle Income ◽

Middle Income Countries ◽

Control Of Diabetes

Download Full-text

Risk factors of perioperative mortality from complicated peptic ulcer disease in Africa: systematic review and meta-analysis

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2019-000350 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000350

Author(s):

Sarah Peiffer ◽

Matthew Pelton ◽

Laura Keeney ◽

Eustina G Kwon ◽

Richard Ofosu-Okromah ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Peptic Ulcer ◽

Peptic Ulcer Disease ◽

Low Income ◽

Meta Analysis ◽

Mortality Rates ◽

Sub Saharan Africa ◽

Perioperative Mortality ◽

Ulcer Disease

IntroductionIn 2013, peptic ulcer disease (PUD) caused over 300 000 deaths globally. Low-income and middle-income countries are disproportionately affected. However, there is limited information regarding risk factors of perioperative mortality rates in these countries.ObjectiveTo assess perioperative mortality rates from complicated PUD in Africa and associated risk factors.DesignWe performed a systematic review and a random-effect meta-analysis of literature describing surgical management of complicated PUD in Africa. We used subgroup analysis and meta-regression analyses to investigate sources of variations in the mortality rates and to assess the risk factors contributing to mortality.ResultsFrom 95 published reports, 10 037 patients underwent surgery for complicated PUD. The majority of the ulcers (78%) were duodenal, followed by gastric (14%). Forty-one per cent of operations were for perforation, 22% for obstruction and 9% for bleeding. The operations consisted of vagotomy (38%), primary repair (34%), resection and reconstruction (12%), and drainage procedures (6%). The overall PUD mortality rate was 6.6% (95% CI 5.4% to 8.1%). It increased to 9.7% (95% CI 7.1 to 13.0) when we limited the analysis to studies published after the year 2000. The correlation was higher between perforated PUD and mortality rates (r=0.41, p<0.0001) than for bleeding PUD and mortality rates (r=0.32, p=0.001). Non-significant differences in mortality rates existed between sub-Saharan Africa (SSA) and North Africa and within SSA.ConclusionPerioperative mortality rates from complicated PUD in Africa are substantially high and could be increasing over time, and there are possible regional differences.

Download Full-text

Mass deworming to improve developmental health and wellbeing of children in low-income and middle-income countries: a systematic review and network meta-analysis

The Lancet Global Health ◽

10.1016/s2214-109x(16)30242-x ◽

2017 ◽

Vol 5 (1) ◽

pp. e40-e50 ◽

Cited By ~ 55

Author(s):

Vivian A Welch ◽

Elizabeth Ghogomu ◽

Alomgir Hossain ◽

Shally Awasthi ◽

Zulfiqar A Bhutta ◽

...

Keyword(s):

Systematic Review ◽

Low Income ◽

Meta Analysis ◽

Middle Income ◽

Middle Income Countries ◽

Health And Wellbeing ◽

Developmental Health

Download Full-text

Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000662 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000662 ◽

Cited By ~ 1

Author(s):

Nick Brown ◽

Antti Juhani Kukka ◽

Andreas Mårtensson

Keyword(s):

Systematic Review ◽

Treatment Failure ◽

Low Income ◽

Meta Analysis ◽

Severe Pneumonia ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries

BackgroundDespite advances in vaccination and case management, pneumonia remains the single largest contributor to early child mortality worldwide. Zinc has immune-enhancing properties, but its role in adjunctive treatment of pneumonia in low-income and middle-income countries (LMICs) is controversial and research still active.MethodsSystematic review and meta-analysis of randomised controlled trials of zinc and placebo in pneumonia in children aged 2 to 60 months in LMICs. Databases included MEDLINE, the Cochrane Library, EMBASE, LILACS, SciELO, the WHO portal, Scopus, Google Scholar and ClinicalTrials.gov. Inclusion criteria included accepted signs of pneumonia and clear measure of outcome. Risk of bias was independently assessed by two authors. ORs with 95% CI were used for calculating the pooled estimate of dichotomous outcomes including treatment failure and mortality. Time to recovery was expressed as HRs. Sensitivity analyses considering risk of bias and subgroup analyses for pneumonia severity were performed.ResultsWe identified 11 trials published between 2004 and 2019 fulfilling the a priori defined criteria, 7 from South Asia and 3 from Africa and 1 from South America. Proportional treatment failure was comparable in both zinc and placebo groups when analysed for all patients (OR 0.95 (95% CI 0.80 to 1.14)) and only for those with severe pneumonia (OR 0.93 (95% CI 0.75 to 1.14)). No difference was seen in mortality between zinc and placebo groups (OR 0.64 (95% CI 0.31 to 1.31)). Time to recovery from severe pneumonia did not differ between the treatment and control groups for patients with severe pneumonia (HR 1.01 (95% CI 0.89 to 1.14)). Removal of four studies with high risk of bias made no difference to the conclusions.ConclusionThere is no evidence that adjunctive zinc treatment improves recovery from pneumonia in children in LMICs.Trial registration numberCRD42019141602.

Download Full-text