scholarly journals Interpreting Kaplan Meier’s survival curve in COVID-19 patients: a systematic review

2020 ◽  
Vol 8 (1) ◽  
pp. 424
Author(s):  
Lata Ajay Tapnikar ◽  
Sneha Patil ◽  
Jaydeep Nyse
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Survival Curve ◽  
Visual Assessment ◽  
World Health ◽  
P Value ◽  
Journal Articles ◽  
Kaplan Meier ◽  
Health Organization ◽  
Study Designs

Covid 19 is the causative agent of coronavirus disease in 2019-2020; was declared a pandemic by the World Health Organization on 11th March 2020. The article aims to interpret the functionality of Kaplan Meier’s survival curve used in various study designs. The search strategy and selection of published works in the MEDLINE database from the National Library of Medicine (NLM) was used to identify original journal articles published in English from March 1, 2020 to September 11, 2020. The search strings in title/abstract were ‘COVID-19’ or ‘coronavirus’ or and ‘Kaplan Meier curve’ that yielded 225 articles. Finally only 28 articles were reviewed. These were clinical trials (N=1), and retrospective (N=10) and prospective (N=1) observational studies (N=2), case control study (N=1) retrospective cohort study (N=6), medical record based study (N=3), observational studies (N=2), not specified (N=1), diagnostic test (N=1). 88% of articles were from China. Kaplan Meier’s curve was depicted in all the studies and 17 were found to be highly significant for KM curve, 2 were found significant as 6 were found to be non significant and in 3 no mention of significance of p value was given. It was concluded that it is the first systematic review to date related to interpreting Kaplan Meier’s survival curve in patients with COVID-19. The  graph has been used singularly, in multiples and cumulatively, thus giving visual assessment which enhances the interpretation of results for survival analysis, failure to time and time to event plots. It is not only used in RCT study designs but a range of observational and retrospective studies.

scholarly journals Parenting Patterns with Sibling Rivalry Incidents in Preschooler: A Systematic Review

2020 ◽  
Vol 1 (2) ◽  
pp. 55-60
Author(s):  
Nessy Anggun Primasari ◽  
Siti Riskika ◽  
Niswa Salamung ◽  
Melinda Restu Pertiwi
Keyword(s):  
Systematic Review ◽  
Preschool Children ◽  
Parenting Style ◽  
Parenting Styles ◽  
Sibling Rivalry ◽  
World Health ◽  
Journal Articles ◽  
Parent Child Interactions ◽  
Level Of Knowledge ◽  
Health Organization

Introduction: Parenting style is a comprehensive unity between parent-child interactions. Different parenting styles in children have an impact on the incidence of sibling rivalry in preschool children. According to WHO (World Health Organization) the incidence of sibling rivalry in parenting, the known data from research on 52 respondents: democratic parenting (32.7%), authoritarian (3.8%), permissive (46.2%), abandonment (17.3%), there was Sibling Rivalry (65.4%) and there was no Sibling Rivalry (34.6%). This paper aims to assess the effect of parenting style on the incidence of sibling rivalry in preschool children. Method: This writing uses a systematic review design. The data is taken from the Science Direct, Poquest and Google Cendikia databases, with a period of 2016-2020. Search for journals and articles using the keywords parenting (parenting), sibling rivalry, prescooler (pre-school children). Result: There were ten selected journal articles from 2508 journal articles found from three databases. All journal articles say that there is a relationship between the type of parenting style of parents and the incidence of sibling rivalry in preschool children. Discussion: The results of the analysis in this systematic review show that modern parents, who have a level of knowledge that continues to develop, are more proactive in seeking information about parenting styles and sibling rivalry. Conclusion: The majority of parenting styles adopted by parents are democratic parenting so that parents become more pro-active in seeking information about the best parenting styles and the incidence of sibling rivalry.

scholarly journals Systematic review of the status of pfhrp2 and pfhrp3 gene deletion, approaches and methods used for its estimation and reporting in Plasmodium falciparum populations in Africa: review of published studies 2010–2019

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Bosco B. Agaba ◽  
Adoke Yeka ◽  
Sam Nsobya ◽  
Emmanuel Arinaitwe ◽  
Joaniter Nankabirwa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Plasmodium Falciparum ◽  
Gene Deletion ◽  
Vital Role ◽  
World Health ◽  
Malaria Rapid Diagnostic Tests ◽  
Single Deletion ◽  
The Status ◽  
Health Organization ◽  
Study Designs

Abstract Background Malaria rapid diagnostic tests based on histidine-rich protein-2 have played a vital role in improving malaria case management and surveillance particularly in Africa, where Plasmodium falciparum is predominant. However, their usefulness has been threatened by the emergence of gene deletion on P. falciparum histidine rich protein 2 (pfhrp2) and P. falciparum histidine rich protein 3 (pfhrp3). Use of standard and recommended methods is key for accurate investigation, confirmation and reporting of pfhrp2 and pfhrp3 gene deletion. Methods A systematic review was conducted to assess the status, methods and approaches that have been used for investigation, confirmation and reporting of pfhrp2 and pfhrp3 gene deletion in Africa. An online search was done using PubMed and MEDLINE Google Scholar for all articles published in English on pfhrp2/3 gene deletion in Africa. Relevant articles that met the inclusion criteria were summarized and assessed based on the protocol recommended by the World Health Organization for confirmation and reporting of pfhrp2/3 gene deletion. Results The search identified a total of 18 articles out of which 14 (77.7%) fulfilled the criteria for inclusion and were retained for review. The articles were distributed across 12 countries where the pfhrp2 and pfhrp3 gene deletion studies were conducted and reported. The level of pfhrp2/3 gene deletion across selected studies in Africa ranged from the highest 62% to the lowest 0.4%. There was wide variation in methods and approaches including study designs, size and sampling and whether both pfhrp2 and pfhrp3 double deletions or pfhrp2 single deletion were investigated, with a wide variation in laboratory methods. Conclusion Based on the review, there is evidence of the presence of pfhrp2/3 gene-deleted P. falciparum parasites in Africa. The approaches and methods used for investigation, confirmation and reporting of pfhrp2/3 deleted parasites have varied between studies and across countries. Countries that are considering plans to investigate, confirm and report pfhrp2/3 deletion should use recommended standard and harmonized methods to prevent unnecessary recommendations for costly switch of RDTs in Africa.

scholarly journals Clinical Presentation of Patients Infected with Coronavirus Disease 19: A Systematic Review

2020 ◽  
Vol 13 ◽  
pp. 117863372095207
Author(s):  
Tadesse Sheleme ◽  
Firomsa Bekele ◽  
Tasissa Ayela
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Clinical Symptoms ◽  
Case Series ◽  
World Health ◽  
Cross Sectional ◽  
Sputum Production ◽  
Novel Coronavirus ◽  
Health Organization ◽  
Study Designs

Background: The coronavirus disease-19 has been labeled a pandemic by World Health Organization. By virtue of its highly contagious attribution, this virus has spread across over the world and the numbers are still rapidly increasing. Increasing numbers of confirmed cases and mortality rates of coronavirus disease 2019 are occurring in several countries. The aim of this systematic review was to summarize clinical presentations of this newly emerging coronavirus disease. Methods: A systematic review of published articles was conducted using databases such as PubMed, Scopus, and Google Scholar. A search was conducted on 18 to 25 April 2020. Search terms included “novel coronavirus,” “2019 novel coronavirus,” “Coronavirus disease 2019,” “COVID-19,” “severe acute respiratory syndrome coronavirus 2.” The studies published in the English language and their full texts available were included. The eligible study designs were cross-sectional, case-control, cohort, and case series. Results: Thirty (30) studies which contain 4829 participants were included in this review. From included studies, the age of infected patients were found in range 0.25 to 94 years. The main clinical symptoms of COVID-19 patients were fever (77.6%), cough (64.8%), fatigue (27.2%), dyspnea (21.2%) and sputum production (18.0%). Conclusion: This systematic review identified that fever, cough, fatigue, and dyspnea were the most common reported clinical features of coronavirus disease 19. Understanding of the clinical spectrum and impact of this novel disease is important for all individuals, especially for healthcare workers to manage and prevent it.

HUBUNGAN TINGKAT STRES DENGAN SIKLUS MENSTRUASI PADA MAHASISWA KEBIDANAN TINGKAT I DI STIKES KUNINGAN TAHUN 2019

2020 ◽  
Vol 1 (1) ◽  
pp. 8
Author(s):  
Fera Riswidautami Herwandar ◽  
Russiska Russiska ◽  
Intan Maharani Fakhrudin
Keyword(s):  
World Health Organization ◽  
World Health ◽  
P Value ◽  
Cross Sectional ◽  
Health Organization

Permasalahan kesehatan pada remaja yang menduduki persentasi terbesar dibanding yang lainnya adalah gangguan menstruasi. Gangguan pada siklus menstruasi (durasi perdarahan yang lebih lama dan ketidakteraturan siklus) disebabkan oleh beberapa faktor, salah satunya ialah stres. Stres diketahui sebagai faktor-faktor penyebab (etiologi) terjadinya gangguan siklus menstruasi. Stres akan memicu pelepasan hormon kortisol dimana hormon kortisol ini dijadikan tolak ukur untuk melihat derajat stres seseorang. Hormon kortisol diatur oleh hipotalamus otak dan kelenjar pituitari, dengan dimulainya aktivitas hipotalamus, hipofisis mengeluarkan FSH dan proses stimulus ovarium akan menghasilkan estrogen. Penelitian yang dilakukan oleh Pelayanan Kesehatan Peduli Remaja (PKPR) dibawah naungan World Health Organization (WHO) menyebutkan bahwa permasalahan remaja di Indonesia adalah seputar permasalahan yang mengenai gangguan menstruasi. Tujuan penelitian ini adalah untuk mengetahui hubungan tingkat stres dengan siklus menstruasi pada mahasiswa kebidanan tingkat I di STIKES Kuningan tahun 2019. Penelitian ini menggunakan desain penelitian kuantitatif dengan pendekatan Cross Sectional. Populasi dalam penelitian ini adalah mahasiswa kebidanan tingkat I di STIKES Kuningan tahun 2019 sebanyak 41 responden. Analisis yang digunakan analisis univariat dan bivariat dengan menggunakan uji Rank Spearman. Hasil penelitian menunjukkan adanya hubungan tingkat stres dengan siklus menstruasi pada mahasiswa kebidanan tingkat I di STIKES Kuningan, dari 41 responden terdapat 18 (44%) responden yang mengalami stres sedang, pada siklus menstruasi yang tidak teratur terdapat 25 (61%) responden. Hasil uji rank spearman,  yakni p value = 0,01 (<0,05) yang ada hubungan antara tingkat stres dengan siklus menstruasi. Berdasarkan hasil penelitian penulis dapat menyimpulkan bahwa terdapat hubungan yang signifikan antara tingkat stres dengan siklus menstruasi pada mahasiswa kebidanan tingkat I di STIKES Kuningan tahun 2019. Bagi institusi Pendidikan khususnya Program Studi Diploma III Kebidanan diharapkan dapat membuat sebuah program edukasi mengenai manajemen stres pada remaja yang bisa dilakukan secara rutin di luar jadwal perkuliahan.  

HUBUNGAN ANTARA PENDIDIKAN DAN SOSIAL EKONOMI KELUARGA DENGAN STATUS GIZI BALITA DI PUSKESMAS KERAMASAN PALEMBANG TAHUN 2012

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Dini Kesumah Dini Kesumah
Keyword(s):  
Nutritional Status ◽  
World Health Organization ◽  
Health Center ◽  
World Health ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Highly Educated ◽  
Health Organization ◽  
Nutritional Status Of Children

ABSTRACT According to World Health Organization Health Organization (WHO) in 2005 showed 49% of deaths occur in children under five in developing countries. Nutritional problems can not be done with the medical and health care approach alone. Causes related to malnutrition that maternal education, socioeconomic families, poor environmental sanitation, and lack of food supplies. This study aims to determine the relationship between education and socioeconomic status of families with nutrition survey using a cross sectional analytic approach, with a population of all mothers of children under five who visited the health center in Palembang Keramasan Accidental sampling Sampling the number of samples obtained 35 respondents. Variables include the study independent and dependent variables and univariate analysis using Chi-Square test statistic with a significance level α = 0.05. The results from 35 respondents indicate that highly educated mothers earned as many as 16 people (45.7%), and middle and upper income families as many as 12 people (34.3%) and bivariate test results show that highly educated respondents toddler nutritional status good for 81.3% (13 people) is larger than the less educated respondents balitanya good nutritional status 26.3% (5 persons) as well as respondents who have middle and upper socioeconomic families with good nutritional status of children at 91.7% ( 11 people) is larger when compared to respondents who have family socioeconomic medium with good nutritional status of children at 30.4% (7 people). Statistical tests show that education has a significant relationship with nutritional status of children P value = 0.004 and socioeconomic families have a meaningful relationship with nutritional status of children P value = 0.002. Based on the results of the study suggested the health professionals in the health center should further improve the education, information about the importance of nutrition to the development of the child in the mothers through the selection and processing of good food and a good diet through health centers and integrated health.   ABSTRAK  Menurut badan kesehatan World Health Organization (WHO) tahun 2005 menunjukkan 49% kematian yang terjadi pada anak dibawah umur lima tahun di negara berkembang. Masalah gizi ini tidak dapat dilakukan dengan pendekatan medis dan pelayanan kesehatan saja. Penyebab yang berhubungan dengan kurang gizi yaitu pendidikan ibu, sosial ekonomi keluarga, sanitasi lingkungan yang kurang baik,dan kurangnya persediaan pangan. Penelitian ini bertujuan untuk mengetahui hubungan antara pendidikan dan sosial ekonomi keluarga dengan status gizi balita dengan menggunakan metode survei analitik pendekatan secara Cross Sectional, dengan populasi semua ibu yang memiliki anak balita yang berkunjung ke Puskesmas Keramasan Palembang dengan pengambilan sampel secara Accidental Sampling diperoleh jumlah sampel 35 responden. Variabel penelitian meliputi variabel independen dan dependen serta analisis univariat menggunakan uji statistik Chi-Square dengan tingkat kemaknaan α = 0,05. Hasil penelitian ini menunjukkan dari 35 responden didapatkan ibu yang berpendidikan tinggi sebanyak 16 orang  (45,7%), dan keluarga yang berpenghasilan menengah keatas sebanyak 12 orang (34,3%) dan hasil uji bivariat menunjukkan bahwa responden yang berpendidikan tinggi status gizi balitanya baik sebesar 81,3% (13 orang) lebih besar bila dibanding responden yang berpendidikan rendah status gizi balitanya baik 26,3% (5 orang) serta responden yang mempunyai sosial ekonomi keluarga menengah keatas dengan status gizi balita baik sebesar 91,7% (11 orang) lebih besar bila dibanding responden yang mempunyai sosial ekonomi keluarga menengah kebawah dengan status gizi balita baik sebesar 30,4% (7 orang). Uji statistik menunjukkan bahwa pendidikan mempunyai hubungan yang bermakna dengan status gizi balita P value = 0,004 dan sosial ekonomi keluarga mempunyai hubungan yang bermakna dengan status gizi balita P value = 0,002. Berdasarkan hasil penelitian disarankan pada petugas kesehatan di Puskesmas hendaknya lebih meningkatkan penyuluhan-penyuluhan tentang pentingnya gizi terhadap tumbuh kembang anak pada ibu-ibu melalui cara pemilihan dan pengolahan bahan makanan yang baik serta pola makanan yang baik melalui kegiatan Puskesmas dan Posyandu.

HUBUNGAN ANTARA PENDIDIKAN DAN PEKERJAAN IBU HAMIL DENGAN PEMERIKSAAN KEHAMILAN DI PUSKESMAS MARIANA KECAMATAN BANYUASIN I KABUPATEN BANYUASIN TAHUN 2011

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Leny Leny
Keyword(s):  
Prenatal Care ◽  
Pregnant Women ◽  
Maternal Education ◽  
Statistical Tests ◽  
Univariate Analysis ◽  
World Health ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Health Organization

ABSTRACT Prenatal care is health care by health personnel to care the pregnant according to standards. Worlrd Health Organization (WHO) estimates more than 500.000 women die during pregnancy or childbirth. Maternal mortality in Indonesia is 307 per 100,000 live births. The quantity of pregnant women’s visit in Kabupaten Banyuasin in 2009 of 89.1%. The purpose of this study to determine the relationship between education and occupation with prenatal care at Puskesmas Mariana  Kecamatan Banyuasin I Kabupaten Banyuasin in 2011. This study uses analytic approach survey by Cross Sectional methods, the population are 1.946 pregnant women and the samples as many as 332 people. The results of univariate analysis study of pregnant women who are higher education as much as 45.2%, and  low maternal education as much as 54.8%. In pregnant women who work of 43.4%, and pregnant women who do not work for 56.6%. From the results of bivariate analysis and Chi-Square statistical tests found a significant association between education of pregnant women with prenatal care with P Value = 0.000, and there was a significant association between occupation of pregnant women with prenatal care with P Value = 0.000. Can be concluded that there is a relationship between education and occupation of pregnant women with prenatal care. Expected to health workers to provide counseling on the importance of prenatal care in pregnant women and expected future studies may explore again the factors associated with prenatal care with the different variables.   ABSTRAK Pemeriksaan kehamilan adalah pelayanan kesehatan oleh tenaga kesehatan untuk memeriksakan ibu hamil sesuai standar. World Health Organization (WHO) memperkirakan lebih dari 500.000 ibu pertahunnya meninggal saat hamil atau bersalin. AKI di Indonesia 307 per 100.000 kelahiran hidup. Jumlah kunjungan ibu hamil di Kabupaten Banyuasin tahun 2009 sebesar 89,1%. Tujuan penelitian ini untuk mengetahui hubungan antara pendidikan dan pekerjaan dengan pemeriksaan kehamilan di Puskesmas Mariana Kecamatan Banyuasin I Kabupaten Banyuasin tahun  2011. Penelitian ini menggunakan metode survey analitik dengan pendekatan Cross Sectional, populasi ibu hamil dengan jumlah 1.946 orang dan jumlah sampel sebanyak 332 orang. Hasil penelitian Analisa Univariat adalah ibu hamil yang pendidikan tinggi sebanyak 45,2%, dan pendidikan rendah ibu hamil sebanyak 54,8%. Pada variabel pekerjaan ibu hamil yang bekerja sebesar 43,4%, dan ibu hamil yang tidak bekerja sebesar 56,6%. Dari hasil analisa bivariat dan uji statistik Chi-Square  didapatkan hubungan yang bermakna antara pendidikan ibu hamil dengan pemeriksaan kehamilan dengan  P Value = 0,000, dan ada hubungan yang bermakna antara pekerjaan ibu hamil dengan pemeriksaan kehamilan dengan P Value = 0,000. Dapat disimpulkan bahwa ada hubungan antara pendidikan dan pekerjaan ibu hamil dengan pemeriksaan kehamilan. Diharapkan kepada petugas kesehatan agar dapat memberikan penyuluhan tentang pentingnya pemeriksaan pada ibu hamil dan diharapkan penelitian yang akan datang dapat menggali lagi faktor-faktor yang berhubungan dengan pemeriksaan kehamilan dengan variabel yang berbeda.

HUBUNGAN LILITAN TALI PUSAT, PARTUS LAMA DAN PLASENTA PREVIA DENGAN KEJADIAN ASFIKSIA NEONATORUM

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Dina Ardyana ◽  
Erma Puspita Sari
Keyword(s):  
World Health Organization ◽  
World Health ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Health Organization

Latar belakang: Berdasarkan data World Health Organization (WHO) setiap tahunnya kira-kira 3%(3,6 juta) dari 120 juta bayi baru lahir mengalami asfiksia,hampir 1 juta bayi ini meninggal. Di Amerika diperkirakan 12.000 bayi meninggal atau menderita kelainan akibat asfiksia perinatal.Sebagian kasus Asfiksia Neonatorum pada bayi baru lahir merupakan kelanjutan dari asfiksia intrauterin. Maka dari itu,diagnosa dini pada penderita Asfiksia merupakan arti penting dalam merencanakan resusitasi yang akan dilakukan.Setelah bayi lahir, diagnosa asfiksia dapat dilakukan dengan menetapkan nilai APGAR. Tujuan: diketahuinya hubungan lilitan tali pusat,partus lama dan plasenta previa dengan kejadian Asfiksia neonatorum di Rumah Sakit “P” Palembang Tahun 2018. Metode: Jenis penelitian yang digunakan adalah survey analitik dengan pendekatan cross sectional. Populasi dalam penelitian seluruh ibu bersalin di zal kebidanan di Rumah Sakit “P” Palembang pada tahun 2018 yang berjumlah 820 orang. Hasil: Hasil analisis univariat diketahui yang mengalami asfiksia neonatorum sebanyak 20 responden (22,5%),yang mengalami plasenta previa sebanyak 15 responden(16,9%),yang mengalami partus lama sebanyak 20 responden (22,5%) dan yang mengalami lilitan tali pusat sebanyak 27 responden (30,3%).Sedangkan hasil uji chi square menunjukan ada hubungan plasenta previa dengan kejadian asfiksia neonatorum dengan p value = 0,000,ada hubungan partus lama dengan kejadian asfiksia neonatorum dengan p value = 0,000,dan ada hubungan lilitan tali pusat dengan kejadian asfiksia neonatorum dengan p value = 0,000. Saran: kepada Pimpinan Rumah Sakit untuk meningkatkan mutu pelayanan kesehatan khususnya mengenai bahaya asfiksia neonatorum. Kata kunci : Lilitan Tali Pusat,Partus Lama,Plasenta Previa,Asfiksia Neonatorum

scholarly journals COVID-19 Vaccination Perception and Attitude among Healthcare Workers in Egypt

2021 ◽  
Vol 12 ◽  
pp. 215013272110133
Author(s):  
Samar Fares ◽  
Merihan M. Elmnyer ◽  
Shimaa Sabry Mohamed ◽  
Radwa Elsayed
Keyword(s):  
Healthcare Workers ◽  
Study Groups ◽  
World Health ◽  
Vaccine Hesitancy ◽  
Accurate Information ◽  
P Value ◽  
Major Barrier ◽  
Vaccination Programs ◽  
The World ◽  
Health Organization

Introduction COVID-19 pandemic has affected the whole world, especially the frontline worriers. To get shielded through this war, the world is racing to reach and manufacture COVID-19 vaccines. Vaccination hesitancy is one of the significant obstacles to global health. Objectives This study aimed to assess the perception and attitude of healthcare workers in Egypt toward COVID-19 vaccines, acknowledge the determinants of their attitude, and the factors that could increase the acceptance of the vaccine. Methods an observational web-based anonymous survey was conducted on 385 Egyptian healthcare workers in different governorates. The questionnaire-based on Vaccine Hesitancy Survey Questions of the World Health Organization was available in Arabic and English languages and was tested for reliability. Results Regarding vaccination decision, 51% of the participants were undecided, 28% refused, and 21% accepted vaccination. Reasons for vaccine acceptance mainly were risks of COVID-19 (93%), safety (57.5%), and effectiveness (56.25%) of the vaccine. Simultaneously, the reasons for vaccine hesitancy were the absence of enough clinical trials (92.4%) and fear of side effects of the vaccine (91.4%). The leading factor that could increase vaccination acceptance among the participants was to get sufficient and accurate information about the available vaccines. The participants revealed a high mean level of concern for COVID-19 vaccines’ safety (3.8 of 5) that differs significantly among the different study groups ( P-value .002). Conclusion Despite the COVID-19 pandemic, only approximately 21% of Egyptian healthcare workers in our study accepted the COVID-19 vaccination. Vaccine hesitancy represents a major barrier to implementing vaccination programs.

scholarly journals A living WHO guideline on drugs to prevent covid-19

BMJ ◽  
2021 ◽  
pp. n526
Author(s):  
François Lamontagne ◽  
Thomas Agoritsas ◽  
Reed Siemieniuk ◽  
Bram Rochwerg ◽  
Jessica Bartoszko ◽  
...  
Keyword(s):  
Systematic Review ◽  
Guideline Development ◽  
Meta Analysis ◽  
World Health ◽  
Policy And Practice ◽  
Assessment Development ◽  
Research Priority ◽  
Health Organization ◽  
Almost All ◽  
Drug Interventions

Abstract Clinical question What is the role of drugs in preventing covid-19? Why does this matter? There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. Recommendation The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). How this guideline was created This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Understanding the new recommendation The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. Updates This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. Readers note This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.

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