Prevalence of antenatal depression in South Asia: a systematic review and meta-analysis

Abstract Background Antenatal depression carries significant adverse implications for the health and well-being of women, babies and their families. While prevalence of perinatal mental disorders in low-and lower-middle-income countries tends to be higher compared to high-income countries, rates tend to vary widely among countries in certain regions such as South Asia. This study estimated the pooled prevalence of antenatal depression in South Asia and examined variations in individual countries. Methods We conducted a systematic review and meta-analysis. A comprehensive search was conducted on thirteen electronic databases and grey sources for articles published between 1·1·2007 and 31·5·2018 from South Asian countries including Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Studies reporting quantitative prevalence estimates of antenatal depression using a validated diagnostic/ screening tool identified, screened and appraised using a two-stage process. A meta-analysis was conducted using the proportion (%) of pregnant women identified as having antenatal depression as the primary outcome. Results Thirty-three studies involving 13,087 pregnant women were included in the meta-analysis. Overall pooled prevalence was 24·57% (95% CI: 19·34, 30·69). Prevalence rates for India (17·74%, 95% CI: 11·19, 26·96) and Sri Lanka (15·87%, 95% CI: 14·04, 17·88) were lower compared to the overall prevalence whereas the rates for Pakistan (32·2%, 95% CI: 23·11, 42·87) and Nepal (50%, 95% CI: 35·64,64·36) were higher. Conclusions While robust prevalence studies are sparse in most South Asian countries, one in four pregnant women is likely to experience antenatal depression in the region. The issue needs to be recognised in health policy and practice for resource allocation and capacity building at regional and national levels for prevention, diagnosis and treatment. Key messages One in four pregnant women is likely to experience antenatal depression in South Asia region. Targeted efforts are needed at national and regional levels for prevention, diagnosis and treatment.

Download Full-text

Prevalence of antenatal depression in South Asia: a systematic review and meta-analysis

Journal of Epidemiology & Community Health ◽

10.1136/jech-2018-211819 ◽

2019 ◽

Vol 73 (8) ◽

pp. 768-777 ◽

Cited By ~ 8

Author(s):

Rahini Mahendran ◽

Shuby Puthussery ◽

Mahendran Amalan

Keyword(s):

Pregnant Women ◽

South Asia ◽

South Asian ◽

Meta Analysis ◽

Antenatal Depression ◽

Future Research ◽

Prevalence Rates ◽

Asian Countries ◽

Policy And Practice ◽

Prevalence Studies

ObjectiveTo estimate the prevalence of antenatal depression in South Asia and to examine variations by country and study characteristics to inform policy, practice and future research.MethodsWe conducted a comprehensive search of 13 databases including international databases and databases covering scientific literature from South Asian countries in addition to Google Scholar and grey sources from 1 January 2007 to 31 May 2018. Studies reporting prevalence estimates of antenatal depression using a validated diagnostic/screening tool were identified, screened, selected and appraised. Primary outcome was proportion (%) of pregnant women identified as having antenatal depression.ResultsThirty-three studies involving 13 087 pregnant women were included in the meta-analysis. Twelve studies were rated as high quality and 21 studies were of moderate quality. Overall pooled prevalence of antenatal depression was 24.3 % (95% Confidence Interval (CI) 19.03 to 30.47). Studies showed a high degree of heterogeneity (I2=97.66%) and evidence of publication bias (p=0.668). Prevalence rates for India (17.74%, 95% CI 11.19 to 26.96) and Sri Lanka (12.95%, 95% CI 8.29 to 19.68) were lower compared with the overall prevalence, whereas prevalence rates for Pakistan (32.2%, 95% CI 23.11 to 42.87) and Nepal (50%, 95% CI 35.64 to 64.36) were higher.ConclusionsWhile robust prevalence studies are sparse in most South Asian countries, available data suggest one in four pregnant women is likely to experience antenatal depression in the region. Findings highlight the need for recognition of the issue in health policy and practice and for resource allocation for capacity building at regional and national levels for prevention, diagnosis and treatment.

Download Full-text

High prevalence of vitamin D insufficiency among South Asian pregnant women: A systematic review and meta-analysis

British Journal Of Nutrition ◽

10.1017/s0007114521004360 ◽

2021 ◽

pp. 1-32

Author(s):

Mahbubul H Siddiqee ◽

Badhan Bhattacharjee ◽

Umme Ruman Siddiqee ◽

Mohammad Meshbhaur Rahman

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Pregnant Women ◽

South Asian ◽

Meta Analysis ◽

Vitamin D Insufficiency ◽

Mitigation Strategies ◽

Significant Heterogeneity ◽

Asian Countries ◽

Pooled Prevalence

Abstract Insufficiency of vitamin D, during pregnancy, is a common cause of various pregnancy-related complications. Despite such insufficiency being frequently reported among South Asian pregnant women, the absence of systematic review and meta-analysis renders the true extent of this problem poorly characterized. In this systematic review, three main databases (PubMed, Scopus, and Google Scholar) were searched for original studies. We included original studies published between 1st January 2001 to 31st December 2019, conducted on pregnant women who lived in South Asian countries and reported the prevalence of vitamin D insufficiency among the study participants. Twenty studies with a total of 7,804 participants from four South Asian countries finally met our selection criteria. Overall pooled prevalence of insufficiency was 65% [95 % CI: 51% to 78%] with a significant heterogeneity (I2 = 99.37 %; p = 0.00). The average level of vitamin D ranged from 9 ng/mL to 24.86 ng/mL with a weighted mean of 16.37 ng/mL (weighted standard deviation 7.13 ng/mL). The highest prevalence of insufficiency was found in Pakistan (76%) followed by India (67%), Bangladesh (64%), and Nepal (14%). Results obtained in this study suggest that vitamin D insufficiency is highly prevalent among South Asian pregnant women. Being the first systematic review in this region, findings from this study will help in future studies and strengthen the evidence for policymakers to develop effective mitigation strategies.

Download Full-text

Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-81057-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sanju Gautam ◽

Nipun Shrestha ◽

Sweta Mahato ◽

Tuan P. A. Nguyen ◽

Shiva Raj Mishra ◽

...

Keyword(s):

Systematic Review ◽

Sri Lanka ◽

Treatment Failure ◽

South Asia ◽

Treatment Outcomes ◽

Meta Analysis ◽

Tb Treatment ◽

Effect Model ◽

Pooled Prevalence ◽

The Impact

AbstractThe escalating burden of diabetes is increasing the risk of contracting tuberculosis (TB) and has a pervasive impact on TB treatment outcomes. Therefore, we conducted this systematic review and meta-analysis to examine the burden of diabetes among TB patients and assess its impact on TB treatment in South Asia (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, India, Pakistan, and Sri Lanka). PubMed, Excerpta Medica Database (EMBASE), and CINAHL databases were systematically searched for observational (cross-sectional, case–control and cohort) studies that reported prevalence of diabetes in TB patients and published between 1 January 1980 and 30 July 2020. A random-effect model for computing the pooled prevalence of diabetes and a fixed-effect model for assessing its impact on TB treatment were used. The review was registered with PROSPERO number CRD42020167896. Of the 3463 identified studies, a total of 74 studies (47 studies from India, 10 from Pakistan, four from Nepal and two from both Bangladesh and Sri-Lanka) were included in this systematic review: 65 studies for the prevalence of diabetes among TB patients and nine studies for the impact of diabetes on TB treatment outcomes. The pooled prevalence of diabetes in TB patients was 21% (95% CI 18.0, 23.0; I2 98.3%), varying from 11% in Bangladesh to 24% in Sri-Lanka. The prevalence was higher in studies having a sample size less than 300 (23%, 95% CI 18.0, 27.0), studies conducted in adults (21%, 95% CI 18.0, 23.0) and countries with high TB burden (21%, 95% CI 19.0, 24.0). Publication bias was detected based on the graphic asymmetry of the funnel plot and Egger’s test (p < 0.001). Compared with non-diabetic TB patients, patients with TB and diabetes were associated with higher odds of mortality (Odds Ratio (OR) 1.7; 95% CI 1.2, 2.51; I2 19.4%) and treatment failure (OR 1.7; 95% CI 1.1, 2.4; I2 49.6%), but not associated with Multi-drug resistant TB (OR 1.0; 95% CI 0.6, 1.7; I2 40.7%). This study found a high burden of diabetes among TB patients in South Asia. Patients with TB-diabetes were at higher risk of treatment failure and mortality compared to TB alone. Screening for diabetes among TB patients along with planning and implementation of preventive and curative strategies for both TB and diabetes are urgently needed.

Download Full-text

The D614G virus mutation enhances anosmia in COVID-19 patients: Evidence from a systematic review and meta-analysis of studies from South Asia

10.1101/2021.08.11.21261934 ◽

2021 ◽

Author(s):

Christopher S von Bartheld ◽

Molly M Hagen ◽

Rafal Butowt

Keyword(s):

Systematic Review ◽

South Asia ◽

South Asian ◽

Virus Entry ◽

Meta Analysis ◽

Virus Binding ◽

Asian Populations ◽

Ethnic Populations ◽

Pooled Prevalence ◽

Virus Strains

The prevalence of chemosensory dysfunction in patients with COVID-19 varies greatly between populations. It is unclear whether such differences are due to factors at the level of the human host, or at the level of the coronavirus, or both. At the host level, the entry proteins which allow virus binding and entry have variants with distinct properties, and the frequency of such variants differs between ethnicities. At the level of the virus, the D614G mutation enhances virus entry to the host cell. Since the two virus strains (D614 and G614) co-existed in the first six months of the pandemic in most populations, it has been difficult to distinguish between contributions of the virus and contributions of the host for anosmia. To answer this question, we conducted a systematic review and meta-analysis of studies in South Asian populations when either the D614 or the G614 virus was dominant. We show that populations infected predominantly with the G614 virus had a much higher prevalence of anosmia (pooled prevalence of 31.8%) compared with the same ethnic populations infected mostly with the D614 virus strain (pooled anosmia prevalence of 5.3%). We conclude that the D614G mutation is a major contributing factor that increases the prevalence of anosmia in COVID-19, and that this enhanced effect on olfaction constitutes a previously unrecognized phenotype of the D614G mutation. The new virus strains that have additional mutations on the background of the D614G mutation can be expected to cause a similarly increased prevalence of chemosensory dysfunctions.

Download Full-text

Prevalence of Common Mental Disorders in South Asia: A Systematic Review and Meta-Regression Analysis

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.573150 ◽

2020 ◽

Vol 11 ◽

Author(s):

Sadiq Naveed ◽

Ahmed Waqas ◽

Amna Mohyud Din Chaudhary ◽

Sham Kumar ◽

Noureen Abbas ◽

...

Keyword(s):

Systematic Review ◽

Mental Disorders ◽

South Asian ◽

Common Mental Disorders ◽

Meta Analysis ◽

Asian Countries ◽

Stimulant Use ◽

Pooled Prevalence ◽

Policymaking And Implementation ◽

Meta Regression Analysis

South Asian countries report the highest prevalence of common mental disorders (CMDs) globally. This systematic review and meta-analysis report the pooled prevalence of CMDs among the South Asian countries. Database searches were conducted in eight electronic databases. Titles, abstracts, full-text screening, and extraction of data on the event rate of 17 indicators of CMDs were performed by two independent reviewers. A total of 160 studies were included and data analysis was done using the Comprehensive Meta-analysis Software (v.3). A prevalence of depressive symptoms was 26.4% among 173,449 participants, alcohol abuse was 12.9% (n = 107,893); anxiety 25.8% (n = 70,058); tobacco smoking 18.6% (n = 84,965); PTSD 17.2% (n = 42,298); mixed anxiety and depression 28.4% (n = 11,102); suicidal behaviors 6.4% (n = 25,043); misuse of opiates 0.8% (n = 37,304); tobacco chewing 21.0% (n = 10,586); use of cannabis 3.4% (n = 10,977); GAD 2.9% (n = 70,058); bipolar disorder 0.6% (n = 7,197); IV drug abuse 2.5% (n = 15,049); panic disorder 0.01% (n = 28,087); stimulant use 0.9% (n = 1,414); OCD 1.6% (n = 8,784) and phobic disorders 1.8% (n = 27,754). This study reported a high prevalence of CMDs in South Asian countries; necessitating further research on psychiatric epidemiology in those contexts. It informs the need for effective policymaking and implementation of culturally appropriate multilevel interventions.

Download Full-text

High prevalence of vitamin D deficiency among the South Asian adults: a systematic review and meta-analysis

BMC Public Health ◽

10.1186/s12889-021-11888-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mahbubul H. Siddiqee ◽

Badhan Bhattacharjee ◽

Umme Ruman Siddiqi ◽

Mohammad MeshbahurRahman

Keyword(s):

Vitamin D ◽

South Asia ◽

Vitamin D Deficiency ◽

South Asian ◽

Meta Analysis ◽

Asian Population ◽

Asian Countries ◽

The South ◽

South Asian Population ◽

Pooled Prevalence

Abstract Background Vitamin-D deficiency is linked to a wide range of chronic and infectious diseases. Body of literature suggested that the prevalence of this deficiency can have geographical variation. Although vitamin D deficiency is frequently reported in the South Asian population, the scarcity of systematic reviews and meta-analysis means the true extent of the disease and the underlying factors causing it are poorly characterized. Methods A systematic search was performed using two databases (PubMed and Scopus) and one search engine (Google Scholar) for original studies on the South Asian population (published from January 1, 2001, to December 31, 2019). Following the search, a random effect meta-analysis was performed to calculate population-level weighted average, the pooled prevalence of deficiency, and heterogeneity of vitamin D among different countries and genders; in addition to South Asia as a whole. Results Our study, based on our selection criteria was narrowed down to a total of 44,717 participants; which spanned over 65 studies from five South Asian countries. Overall, the pooled prevalence of deficiency was 68% [95% CI: 64 to 72%] with significant heterogeneity (I2 = 98%; p = 0.00). The average level of vitamin D ranged from 4.7 to 32 ng/mL, with a weighted mean of 19.15 ng/mL (weighted standard deviation 11.59 ng/mL). The highest prevalence of vitamin D deficiency was found in Pakistan (73%;95% CI: 63 to 83%) followed by Bangladesh (67%; 95% CI: 50 to 83%), India (67%; 95% CI: 61 to 73%), Nepal (57%; 95% CI: 53 to 60%) and Sri Lanka (48%; 95% CI: 41 to 55%), respectively. This finding indicated a high degree of heterogeneity among the population. (I2 = 98.76%), Furthermore, a gender-wise analysis suggested that in South Asia, the prevalence of vitamin D deficiency was higher in females than males. Conclusion Our findings reveal highly prevalent and variable vitamin D deficiency among the adults of different South Asian countries. Findings from this review would be helpful to generate hypotheses and explore the factors affecting the inter-country variability, alongside strengthening evidence for governments to prioritize mitigation strategies in this region.

Download Full-text

Pooled estimate of vitamin D deficiency among pregnant women in India: a systematic review and meta-analysis

Journal of Health Population and Nutrition ◽

10.1186/s41043-021-00253-y ◽

2021 ◽

Vol 40 (1) ◽

Author(s):

Angeline Jeyakumar ◽

Vidhya Shinde ◽

Reshma Ravindran

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Pregnant Women ◽

Vitamin D Deficiency ◽

Meta Analysis ◽

Health Concern ◽

Study Quality ◽

Care Services ◽

Pooled Prevalence ◽

Women In India

Abstract Background Vitamin D deficiency among pregnant women is a public health concern globally. In India, individual studies report high prevalence. However, lack of national data masks the true burden. This work determined the pooled prevalence of vitamin D deficiency among pregnant women in India through a systematic review of literature and meta-analysis. Methods Three different search engines yielded 15 eligible articles. Study quality was assessed by 10 different criteria and summary of study quality was categorized as per Cochrane standards. Meta-analysis was performed to estimate pooled prevalence of vitamin D deficiency among healthy pregnant women and heterogeneity among selected studies. A sample of n = 4088 was used to study the pooled prevalence among pregnant women. Results The random effects combined estimate was 32.35% (95% CI, (12.58–117.48). High heterogeneity (tau2 = 0.39, I2 = 100%) and high risk of bias was observed among the selected studies. The test for overall effect was observed to be z = 2.54(P = 0.01). Conclusion Pooled estimate > 30% emphasizes the need for screening through antenatal care services and initiate preventive measures to address the deficiency.

Download Full-text

Suicide methods in South Asia over two decades (2001–2020)

International Journal of Social Psychiatry ◽

10.1177/00207640211015700 ◽

2021 ◽

pp. 002076402110157

Author(s):

S M Yasir Arafat ◽

Syeda Ayat-e-Zainab Ali ◽

Vikas Menon ◽

Fahad Hussain ◽

Daniyal Shabbir Ansari ◽

...

Keyword(s):

Sri Lanka ◽

South Asia ◽

South Asian ◽

English Language ◽

Public Health Problem ◽

Asian Countries ◽

Pubmed Central ◽

Suicide Methods ◽

Search Terms ◽

Quantitative Studies

Background: Suicide is a global preventable public health problem. About a quarter of all suicides in the world occur in South Asia. As means restriction is an important suicide prevention strategy, gaining knowledge of the common suicide methods and their changing trends in each country and region is crucial. Aims: We aimed to assess the suicide methods in South Asian countries over the last two decades. Methods: A search was performed in PubMed, PubMed Central, Scopus, and Google Scholar with the search terms. Original articles of quantitative studies, published in the English language, from 2001 to 2020, with full-accessible text, that rank different methods of suicide in eight South Asian countries, were included. Results: A total of 68 studies were found eligible for review. The Maximum number of studies were found from India ( n = 38), followed by Bangladesh ( n = 12), Pakistan ( n = 9), Sri Lanka ( n = 6), and Nepal ( n = 3). Hanging ( n = 40, 55.8%) and poisoning ( n = 24, 35.3%) were the two most common suicide methods reported, in that order. Hanging followed by poisoning were the commonest suicide methods in Bangladesh, India, and Pakistan while in Sri Lanka, poisoning was the preferred method to hanging. There is a decline in suicide by poisoning and an increase in suicide by hanging in Sri Lanka, Bangladesh, and India. Although hanging is still the commonest method in Pakistan, the use of firearms is growing in recent years (2011–2020). Conclusions: There is a steady decline in the incidence of suicides by poisoning following pesticide regulations in South Asian countries. However, there is heterogeneity of study methods, probable under-reporting of suicide, and lack of robust suicide data.

Download Full-text

Post-Stroke Psychiatric and Cognitive Symptoms in West Asia, South Asia and Africa: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10163655 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3655

Author(s):

Sangeetha Mahadevan ◽

Moon Fai Chan ◽

Marzieh Moghadas ◽

Maithili Shetty ◽

David T. Burke ◽

...

Keyword(s):

Systematic Review ◽

South Asia ◽

Rating Scale ◽

Meta Analysis ◽

Grey Literature ◽

Depression Scale ◽

Stroke Survivors ◽

Cognitive Symptoms ◽

Post Stroke ◽

Pooled Prevalence

Recent research has shown that the prevalence of stroke incidents and the number of survivors in developing countries surpass those from developed countries. This study aimed to enumerate the prevalence of post-stroke psychiatric and cognitive symptoms among stroke survivors from West and South Asia and Africa through a systematic review and meta-analysis. Data from each country was systematically acquired from five major databases (PsycINFO, Web of Science, Scopus, PubMed/Medline, and Google Scholar (for any missing articles and grey literature)). Meta-analytic techniques were then used to estimate the prevalence of various post-stoke psychiatric and cognitive symptoms. A total of 36 articles were accrued from 11 countries, of which 25 were evaluated as part of the meta-analysis. The pooled prevalence of post-stroke depression as per the Hospital Anxiety and Depression Scale (HADS), Hamilton Depression Rating Scale, Patient Health Questionnaire, Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Geriatric Depression Scale, and the Montgomery–Asberg Depression Rating Scale ranged from 28.00 to 50.24%. Pooled prevalence of post-stroke anxiety based on the HADS and SCAN was 44.19% and 10.96%, respectively. The pooled prevalence of post-stroke cognitive impairment as per the Mini-Mental Status Examination was 16.76%. This present review has suggested that both psychiatric and cognitive symptoms are common among stroke survivors. Concerted efforts are needed to institute robust studies using culturally sensitive measures to contemplate mechanisms that address the unmet needs of this vulnerable population.

Download Full-text

Prevalence of Syphilis among Pregnant Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2019/4562385 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Siraj Hussen ◽

Birkneh Tilahun Tadesse

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Screening Program ◽

Meta Analysis ◽

Relevant Literature ◽

Sub Saharan Africa ◽

Cochrane Library ◽

Forest Plot ◽

Pooled Prevalence ◽

Sub Saharan

Objective. Syphilis is one of the most imperative STIs, caused by the spirochete Treponema pallidum. During pregnancy it is associated with disastrous health outcomes in the newborn. In sub-Saharan Africa, study findings on the prevalence of syphilis among pregnant women are highly dispersed and inconsistent. The aim of the current review is to conduct a systematic review and meta-analysis of syphilis in sub-Saharan Africa among pregnant women. Design. Systematic review and meta-analysis. Data Sources. Databases including MEDLINE, PubMed, Cochrane Library, Google Scholar, and HINARI and reference lists of previous prevalence studies were systematically searched for relevant literature from January 1999 to November 2018. Results were presented in forest plot, tables, and figures. Random-effects model was used for the meta-analysis. For the purpose of this review, a case of syphilis was defined as positive treponemal or nontreponemal tests among pregnant women. Data Extraction. Our search gave a total of 262 citations from all searched databases. Of these, 44 studies fulfilling the inclusion criteria and comprising 175,546 subjects were finally included. Results. The pooled prevalence of syphilis among pregnant women in sub-Saharan Africa was 2.9% (95%CI: 2.4%-3.4%). East and Southern African regions had a higher syphilis prevalence among pregnant women (3.2%, 95% CI: 2.3%-4.2% and 3.6%, 95%CI: 2.0%-5.1%, respectively) than the sub-Saharan African pooled prevalence. The prevalence of syphilis among pregnant women in most parts of the region seemed to have decreased over the past 20 years except for the East African region. However, prevalence did not significantly differ by region and time period. Conclusion. This review showed a high prevalence of syphilis in sub-Saharan Africa among pregnant women. The evidence suggests strengthening the screening program during pregnancy as part of the care package during antenatal care visits. Programs focusing on primary prevention of syphilis in women should also be strengthened.

Download Full-text