Prognostic models for adverse pregnancy outcomes in low-income and middle-income countries: a systematic review

IntroductionNinety-nine per cent of all maternal and neonatal deaths occur in low-income and middle-income countries (LMIC). Prognostic models can provide standardised risk assessment to guide clinical management and can be vital to reduce and prevent maternal and perinatal mortality and morbidity. This review provides a comprehensive summary of prognostic models for adverse maternal and perinatal outcomes developed and/or validated in LMIC.MethodsA systematic search in four databases (PubMed/Medline, EMBASE, Global Health Library and The Cochrane Library) was conducted from inception (1970) up to 2 May 2018. Risk of bias was assessed with the PROBAST tool and narratively summarised.Results1741 articles were screened and 21 prognostic models identified. Seventeen models focused on maternal outcomes and four on perinatal outcomes, of which hypertensive disorders of pregnancy (n=9) and perinatal death including stillbirth (n=4) was most reported. Only one model was externally validated. Thirty different predictors were used to develop the models. Risk of bias varied across studies, with the item ‘quality of analysis’ performing the least.ConclusionPrognostic models can be easy to use, informative and low cost with great potential to improve maternal and neonatal health in LMIC settings. However, the number of prognostic models developed or validated in LMIC settings is low and mirrors the 10/90 gap in which only 10% of resources are dedicated to 90% of the global disease burden. External validation of existing models developed in both LMIC and high-income countries instead of developing new models should be encouraged.PROSPERO registration numberCRD42017058044.

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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.

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Investigating the use of ultrasonography for the antenatal diagnosis of structural congenital anomalies in low-income and middle-income countries: systematic review protocol

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000538 ◽

2019 ◽

Vol 3 (1) ◽

pp. e000538 ◽

Cited By ~ 1

Author(s):

Stephanie Michele Goley ◽

Sidonie Sakula-Barry ◽

Ann Kelly ◽

Naomi Wright

Keyword(s):

Systematic Review ◽

Health Outcomes ◽

Low Income ◽

Congenital Anomalies ◽

Antenatal Diagnosis ◽

Risk Of Bias ◽

Cochrane Library ◽

Middle Income ◽

Antenatal Ultrasound ◽

Middle Income Countries

IntroductionCongenital anomalies are the fifth leading cause of mortality in children under 5 years globally. The greatest burden is faced by those in developing countries, where over 95% of deaths occur. Many of these deaths may have been preventable through antenatal diagnosis and early intervention. This study aims to conduct a systematic review that investigates the use of antenatal ultrasound to diagnose congenital anomalies and improve the health outcomes of infants in low-income and middle-income countries (LMICs).Methods and analysisA systematic literature review will be conducted using three search strings: (1) structural congenital anomalies, (2) LMICs and (3) antenatal diagnosis. Four electronic databases will be searched: MEDLINE, Embase, PubMed and the Cochrane Library. Title, abstract and full-text screening will be undertaken in duplicate by two reviewers independently using Covidence. Consensus will be sought from the wider authorship for discrepancies. Data extraction will be undertaken by the principal investigator. The primary analysis will focus on the availability and effectiveness of antenatal ultrasound for structural congenital anomalies. Secondary outcomes will include neonatal morbidity and mortality, termination rates and referral rates for further antenatal care. Descriptive statistics and a narrative synthesis will be included in the final report. The methodological quality of the included studies will be evaluated using the Cochrane-approved Risk of Bias for Non-Randomised Studies of Intervention and Risk of Bias in Randomised Trials V.2.0 tools.Ethics and disseminationEthical approval is not required for conducting the systematic review as there will be no direct collection of data from individuals. The results will be submitted for publication in a scientific journal and presented internationally.ConclusionThis is the first study, to our knowledge, to systematically review current literature on the use of antenatal ultrasound for the detection of congenital anomalies in LMICs. This is vital to define current practice, highlight global disparities and evaluate effects on health outcomes for infants in low-resource settings.PROSPERO registration numberCRD42019105620.

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Adverse pregnancy and neonatal outcomes associated with Neisseria gonorrhoeae: systematic review and meta-analysis

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054653 ◽

2021 ◽

Vol 97 (2) ◽

pp. 104-111

Author(s):

Lisa M Vallely ◽

Dianne Egli-Gany ◽

Handan Wand ◽

William S Pomat ◽

Caroline S E Homer ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Perinatal Mortality ◽

Low Income ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Middle Income ◽

Middle Income Countries ◽

Adverse Pregnancy

Objective To examine associations between Neisseria gonorrhoeae (NG) infection during pregnancy and the risk of preterm birth, spontaneous abortion, premature rupture of membranes, perinatal mortality, low birth weight and ophthalmia neonatorum. Data sources We searched Medline, EMBASE, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature for studies published between 1948 and 14 January 2020. Methods Studies were included if they reported testing for NG during pregnancy and compared pregnancy, perinatal and/or neonatal outcomes between women with and without NG. Two reviewers independently assessed papers for inclusion and extracted data. Risk of bias was assessed using established checklists for each study design. Summary ORs with 95% CIs were generated using random effects models for both crude and, where available, adjusted associations. Results We identified 2593 records and included 30 in meta-analyses. Women with NG were more likely to experience preterm birth (OR 1.55, 95% CI 1.21 to 1.99, n=18 studies); premature rupture of membranes (OR 1.41, 95% CI 1.02 to 1.92, n=9); perinatal mortality (OR 2.16, 95% CI 1.35 to 3.46, n=9); low birth weight (OR 1.66, 95% CI 1.12 to 2.48, n=8) and ophthalmia neonatorum (OR 4.21, 95% CI 1.36 to 13.04, n=6). Summary adjusted ORs were, for preterm birth 1.90 (95% CI 1.14 to 3.19, n=5) and for low birth weight 1.48 (95% CI 0.79 to 2.77, n=4). In studies with a multivariable analysis, age was the variable most commonly adjusted for. NG was more strongly associated with preterm birth in low-income and middle-income countries (OR 2.21, 95% CI 1.40 to 3.48, n=7) than in high-income countries (OR 1.38, 95% CI 1.04 to 1.83, n=11). Conclusions NG is associated with a number of adverse pregnancy and newborn outcomes. Further research should be done to determine the role of NG in different perinatal mortality outcomes because interventions that reduce mortality will have the greatest impact on reducing the burden of disease in low-income and middle-income countries. PROSPERO registration number CRD42016050962.

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Theory of change for the delivery of talking therapies by lay workers to survivors of humanitarian crises in low-income and middle-income countries: protocol of a systematic review

BMJ Open ◽

10.1136/bmjopen-2017-018193 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018193 ◽

Cited By ~ 2

Author(s):

Grace Kathryn Ryan ◽

Andreas Bauer ◽

Judith K Bass ◽

Julian Eaton

Keyword(s):

Mental Health ◽

Systematic Review ◽

Low Income ◽

Tertiary Education ◽

Grey Literature ◽

Theory Of Change ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries ◽

Humanitarian Crises

IntroductionThere is a severe shortage of specialist mental healthcare providers in low-income and middle-income countries (LMICs) affected by humanitarian crises. In these settings, talking therapies may be delivered by non-specialists, including lay workers with no tertiary education or formal certification in mental health. This systematic review will synthesise the literature on the implementation and effectiveness of talking therapies delivered by lay workers in LMICs affected by humanitarian crises, in order to develop a Theory of Change (ToC).Methods and analysisQualitative, quantitative and mixed-methods studies assessing the implementation or effectiveness of lay-delivered talking therapies for common mental disorders provided to adult survivors of humanitarian crises in LMICs will be eligible for inclusion. Studies set in high-income countries will be excluded. No restrictions will be applied to language or year of publication. Unpublished studies will be excluded. Seven electronic databases will be searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library and ClinicalTrials.gov. Contents pages of three peer-reviewed journals will be hand-searched. Sources of grey literature will include resource directories of two online mental health networks (MHPSS.net and MHInnovation.net) and expert consultation. Forward and backward citation searches of included studies will be performed. Two reviewers will independently screen studies for inclusion, extract data and assess study quality. A narrative synthesis will be conducted, following established guidelines. A ToC map will be amended iteratively to take into account the review results and guide the synthesis.Ethics and disseminationFindings will be presented in a manuscript for publication in a peer-reviewed journal and disseminated through a coordinated communications strategy targeting knowledge generators, enablers and users.PROSPERO registration numberCRD42017058287.

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Voices from low-income and middle-income countries: a systematic review protocol of primary healthcare interventions within public health systems addressing intimate partner violence against women

BMJ Open ◽

10.1136/bmjopen-2017-019266 ◽

2018 ◽

Vol 8 (3) ◽

pp. e019266 ◽

Cited By ~ 5

Author(s):

Marcos Claudio Signorelli ◽

Stav Hillel ◽

Daniel Canavese de Oliveira ◽

Beatriz Paulina Ayala Quintanilla ◽

Kelsey Hegarty ◽

...

Keyword(s):

Public Health ◽

Systematic Review ◽

Health Systems ◽

Low Income ◽

Partner Violence ◽

Intimate Partner ◽

Risk Of Bias ◽

Middle Income ◽

Public Health Systems ◽

Middle Income Countries

IntroductionIntimate partner violence (IPV) considerably harms the health, safety and well-being of women. In response, public health systems around the globe have been gradually implementing strategies. In particular, low-income and middle-income countries (LMIC) have been developing innovative interventions in primary healthcare (PHC) addressing the problem. This paper describes a protocol for a systematic review of studies addressing the impacts and outcomes of PHC centre interventions addressing IPV against women from LMIC.Methods and analysisA systematic search for studies will be conducted in African Index Medicus, Africa Portal Digital Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Index Medicus for the Southeast Asia Region, IndMed, Latin American and Caribbean Health Science Literature Database (LILACS), Medecins Sans Frontieres, MEDLINE, Minority Health and Health Equity Archive, ProQuest, PsycINFO, Scientific Electronic Library Online, (SciELO) and Social Policy and Practice. Studies will be in English, Spanish and Portuguese, published between 2007 and 2017, addressing IPV against women from LMIC, whose data quantitatively report on the impacts and outcomes for survivors and/or workers and/or public health systems preintervention and postintervention. Two trilingual reviewers will independently screen for study eligibility and data extraction, and a librarian will cross-check for compliance. Risk of bias and quality assessment of studies will be measured according to: (1) the Cochrane Collaboration’s tool for assessing risk of bias for randomised controlled trials and (2) the Methodological Index for Non-Randomised Studies (MINORS). Data will be analysed and summarised using meta-analysis and narrative description of the evidence across studies. This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols(PRISMA P) guidelines.Ethics and disseminationThis systematic review will be based on published studies, thus not requiring ethical approval. Findings will be presented in conferences and published in a peer-reviewed journal.PROSPERO registration numberCRD42017069261.

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What interventions are effective in improving uptake and retention of HIV-positive pregnant and breastfeeding women and their infants in prevention of mother to child transmission care programmes in low-income and middle-income countries? A systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-024907 ◽

2019 ◽

Vol 9 (7) ◽

pp. e024907 ◽

Cited By ~ 5

Author(s):

Lisa M Puchalski Ritchie ◽

Monique van Lettow ◽

Ba Pham ◽

Sharon E Straus ◽

Mina C Hosseinipour ◽

...

Keyword(s):

Systematic Review ◽

Antenatal Care ◽

Low Income ◽

Meta Analysis ◽

Risk Of Bias ◽

Hiv Positive ◽

Child Transmission ◽

Middle Income ◽

Middle Income Countries ◽

Mother To Child

ObjectiveThis review was conducted to identify interventions effective in improving uptake and retention of HIV-positive mothers and their infants in prevention of mother to child transmission (PMTCT) services in low-income and middle-income countries (LMICs) in order to inform programme planning.MethodsWe conducted a systematic review of studies comparing usual care with any intervention to improve uptake and retention of HIV-positive pregnant or breastfeeding women and their children from birth to 2 years of age in PMTCT services in LMICs. Twenty-two electronic databases were searched from inception to 15 January 2018, for randomised, quasi-randomised and non-randomised controlled trials, and interrupted time series studies; reference lists of included articles were searched for relevant articles. Risk of bias was assessed using the Cochrane Effective Practice and Organisation of Care group criteria. Random-effects meta-analysis was conducted for studies reporting similar interventions and outcomes.ResultsWe identified 29 837 articles, of which 18 studies were included in our review. Because of heterogeneity in interventions and outcome measures, only one meta-analysis of two studies and one outcome was conducted; we found a statistically significant increase in antiretroviral therapy (ART) use during pregnancy for integration of HIV and antenatal care relative to standard non-integrated care (pooled AOR=2.69; 95% CI 1.25 to 5.78, p=0.0113). The remaining studies assessing other patient, provider or health system interventions were synthesised narratively, with small effects seen across intervention categories for both maternal and infant PMTCT outcomes based predominately on evidence with moderate to high risk of bias.ConclusionsEvidence on the effectiveness of interventions to improve uptake and retention of mothers and infants in PMTCT care is lacking. Our findings suggest that integration of HIV and antenatal care may improve ART use during pregnancy. Future studies to replicate promising approaches are needed. Improved reporting of key methodological criteria will facilitate interpretation of findings and improve the utility of evidence to PMTCT programme planners.PROSPERO registration numberCRD42015020829.

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The impact of user charges on health outcomes in low-income and middle-income countries: a systematic review

BMJ Global Health ◽

10.1136/bmjgh-2018-001087 ◽

2019 ◽

Vol 3 (Suppl 3) ◽

pp. e001087 ◽

Cited By ~ 4

Author(s):

Vicky Mengqi Qin ◽

Thomas Hone ◽

Christopher Millett ◽

Rodrigo Moreno-Serra ◽

Barbara McPake ◽

...

Keyword(s):

Health Outcomes ◽

Low Income ◽

Risk Of Bias ◽

Lower Income ◽

Study Quality ◽

Middle Income ◽

User Charges ◽

Middle Income Countries ◽

The Impact ◽

The Relationship

BackgroundUser charges are widely used health financing mechanisms in many health systems in low-income and middle-income countries (LMICs) due to insufficient public health spending on health. This study systematically reviews the evidence on the relationship between user charges and health outcomes in LMICs, and explores underlying mechanisms of this relationship.MethodsPublished studies were identified via electronic medical, public health, health services and economics databases from 1990 to September 2017. We included studies that evaluated the impact of user charges on health in LMICs using randomised control trial (RCT) or quasi-experimental (QE) study designs. Study quality was assessed using Cochrane Risk of Bias and Risk of Bias in Non-Randomized Studies—of Intervention for RCT and QE studies, respectively.ResultsWe identified 17 studies from 12 countries (five upper-middle income countries, five lower-middle income countries and two low-income countries) that met our selection criteria. The findings suggested a modest relationship between reduction in user charges and improvements in health outcomes, but this depended on health outcomes measured, the populations studied, study quality and policy settings. The relationship between reduced user charges and improved health outcomes was more evident in studies focusing on children and lower-income populations. Studies examining infectious disease–related outcomes, chronic disease management and nutritional outcomes were too few to draw meaningful conclusions. Improved access to healthcare as a result of reduction in out-of-pocket expenditure was identified as the possible causal pathway for improved health.ConclusionsReduced user charges were associated with improved health outcomes, particularly for lower-income groups and children in LMICs. Accelerating progress towards universal health coverage through prepayment mechanisms such as taxation and insurance can lead to improved health outcomes and reduced health inequalities in LMICs.Trial registration numberCRD 42017054737.

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Prevalence and factors associated with suicide among medical professionals in low/middle-income countries: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2018-028884 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028884

Author(s):

Godfrey Zari Rukundo ◽

Helen Byakwaga ◽

Alison Kinengyere ◽

Achille Mwira Bapolisi ◽

Miriela Betancourt ◽

...

Keyword(s):

Suicidal Ideation ◽

Risk Of Bias ◽

Cochrane Library ◽

Medical Professionals ◽

Data Set ◽

Middle Income ◽

Factors Associated ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Statistical Heterogeneity

IntroductionA number of studies in low/middle-income countries (LMICs) have reported varying prevalence of suicide among medical professionals with low rates. This may be because of the methods used in suicide assessment and the stigma associated with it. For this study, the prevalence of suicidal ideation, attempt and completed suicide, as well as the factors associated with suicidality and methods used during suicidal acts, will be documented.Methods and analysisStudies published in peer-reviewed journals in which the prevalence and factors associated with suicidal ideation, attempt and completion among medical professionals in LMICs will be included. The Cochrane Library (CENTRAL), PsychINFO, PubMed and Embase will be systematically searched. We will search for all the papers available in the databases up to March 31 2019. Methodological quality of the articles will be assessed using the quality in prognostic studies tool. The risk of bias of the articles will be assessed using Cochrane risk of bias assessment tool for non-randomised studies. In the event of no statistical heterogeneity, a meta-analysis of the findings will be conducted.Ethics and disseminationEthical permission will not be required since this work does not involve the use of participant data that can be used to identify individuals. Findings from this study will be available for clinicians and other medical professionals, scientists and policy makers. On request, a data set of the study can be provided.Trial registration numberCRD42018095990.

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Knowledge, attitudes and experiences of self-harm and suicide in low-income and middle-income countries: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-041645 ◽

2021 ◽

Vol 11 (6) ◽

pp. e041645

Author(s):

Rebecca McPhillips ◽

Sadia Nafees ◽

Anam Elahi ◽

Saqba Batool ◽

Murali Krishna ◽

...

Keyword(s):

Systematic Review ◽

Low Income ◽

Suicidal Behaviour ◽

Open Access Journal ◽

Cochrane Library ◽

Business Law ◽

Middle Income ◽

Social Burden ◽

Middle Income Countries ◽

Self Harm

IntroductionOver 800 000 people die due to suicide each year and suicide presents a huge psychological, economic and social burden for individuals, communities and countries as a whole. Low-income and middle-income countries (LMICs) are disproportionately affected by suicide. The strongest risk factor for suicide is a previous suicide attempt, and other types of self-harm have been found to be robust predictors of suicidal behaviour. An approach that brings together multiple sectors, including education, labour, business, law, politics and the media is crucial to tackling suicide and self-harm. The WHO highlights that evaluations of the knowledge and attitudes that priority groups, not only healthcare staff, have of mental health and suicidal behaviour are key to suicide prevention strategies. The aim of this systematic review is to examine the knowledge, attitudes and experiences different stakeholders in LMICs have of self-harm and suicide.Methods and analysisMEDLINE, Embase, PsycINFO, CINAHL, BNI, Social Sciences and Cochrane Library will be searched. Reviewers working independently of each other will screen search results, select studies for inclusion, extract and check extracted data, and rate the quality of the studies using the Strengthening the Reporting of Observational studies in Epidemiology and Critical Appraisals Skills Programme checklists. In anticipation of heterogeneity, a narrative synthesis of quantitative studies will be provided and metaethnography will be used to synthesise qualitative studies.Ethics and disseminationEthical approval is not required. A report will be provided for the funding body, and the systematic review will be submitted for publication in a high-impact, peer-reviewed, open access journal. Results will also be disseminated at conferences, seminars, congresses and symposia, and to relevant stakeholders.PROSPERO registration numberCRD42019135323.

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The Magnitude of Unsafe Child Feces Disposal Practices and Its Association With Reported Diarrhea in Low-income and Middle-income Countries: A Systematic Review and Meta-analysis Protocol

10.21203/rs.3.rs-50165/v1 ◽

2020 ◽

Author(s):

Negasa Eshete Soboksa ◽

Bekam Kebede Olkeba ◽

Dinkinesh Begna Gudeta

Keyword(s):

Systematic Review ◽

Low Income ◽

Current Evidence ◽

Cochrane Library ◽

Secondary Outcome ◽

Future Research ◽

Childhood Diarrhea ◽

Middle Income ◽

Middle Income Countries ◽

Google Search

Abstract Introduction:The unsafe disposal of children’s feces may be an important contaminant in household environments, posing a high risk of exposure to infants. Several studies done on the magnitude of unsafe disposal of child feces and its association with reported childhood diarrheahave variedoutcomesand no tries have been made to systematically review this. Therefore, itis necessitating a systematic review to provide an exhaustive summary of current evidence. Thus, the objective ofthis study will be to pool out the available evidence on the magnitude of unsafe child feces disposalpractices and its association with reported childhood diarrhea in low-income and middle-income countries. Methods: PubMed, Science Direct, Cochrane Library database, and Ovid Medline will be searched to identify relevant literature for this review. Moreover, Google search engine, Google Scholar, and references of other studieswill be searched from January 2000 to December 2020. The primary outcome of interest will bethe magnitude of unsafe disposal of child feces and the secondary outcome will be its association with reported diarrhea. Observationalstudies (cross-sectional studies, case-control studies, and cohort studies) written in English will be included in this review. The selected studies will be critically appraised by two independent reviewers using an appropriate tool. The pooled magnitude of unsafe disposal of child feces and its association with reported childhood diarrhea will be analyzed using Stata version 16. Heterogeneity will be assessed using the chi-square test (Q-test) statistics and inverse variance index (I2). Forest plots will be used to present the combined estimate with 95% CI.A funnel plot and Egger’s test of small study bias will be used to assess publication bias.Discussion:This systematic review will identify the evidence available on themagnitude of unsafe child fecesdisposal practicesand its associationwith reported diarrhea. The findings from this study will bemade publicly available in a repository and published in a peer-reviewed journal. The findings from this study will also provide directions for future research and public health professionals with an understanding of the importance of safe child feces disposal practices to preventingchildhood diarrhea in the community.Systematic review registrationnumber: PROSPERO CRD42020189034

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