Prevalence and incidence of cancer related lymphedema in low and middle-income countries: A systematic review and meta-analysis

Abstract Background Little is known about the prevalence and incidence in low and middle-income countries (LMICs) of secondary lymphedema due to cancer. This study aims to estimate the prevalence and incidence in LMICs of secondary lymphedema related to cancer and/or its treatment(s) and identify risk factors. Method A systematic review and meta-analysis was conducted. Medline, EMBASE and CINAHL were searched in June 2019 for peer-reviewed articles that assessed prevalence and/or incidence of cancer-related lymphedema in LMICs. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Estimates of pooled prevalence and incidence estimates were calculated with 95% confidence intervals (CI), with sub-group analyses grouping studies according to: country of origin, study design, risk of bias, setting, treatment, and lymphedema site and measurement. Heterogeneity was measured using X ² and I 2 , with interpretation guided by the Cochrane Handbook for Systematic Reviews. Results Of 8766 articles, 36 were included. Most reported on arm lymphedema secondary to breast cancer treatment (n=31), with the remainder reporting on leg lymphedema following gynecological cancer treatment (n=5). Arm lymphedema was mostly measured by arm circumference (n=16/31 studies), and leg lymphedema through self-report (n=3/5 studies). Eight studies used more than one lymphedema measurement. Only two studies that measured prevalence of leg lymphedema could be included in a meta-analysis (pooled prevalence =10.0%, 95%CI 7.0 – 13.0, I 2 =0%). The pooled prevalence of arm lymphedema was 27%, with considerable heterogeneity (95%CI 20.0 – 34.0, I 2 =94.69%, n =13 studies). The pooled incidence for arm lymphedema was 21%, also with considerable heterogeneity (95%CI 15.0 – 26.0, I 2 =95.29%, n =11 studies). There was evidence that higher BMI (>25) was associated with increased risk of arm lymphedema (OR: 1.98, 95%CI 1.45 – 2.70, I 2 =84.0%, P< 0.0001, n =4 studies). Conclusion Better understanding the factors that contribute to variability in cancer-related arm lymphedema in LMICs is an important first step to developing targeted interventions to improve quality of life. Standardising measurement of lymphedema globally and better reporting would enable comparison within the context of information about cancer treatments and lymphedema care.

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Prevalence and incidence of cancer related lymphedema in low and middle-income countries: A systematic review and meta-analysis.

10.21203/rs.3.rs-20782/v2 ◽

2020 ◽

Author(s):

Eric Torgbenu ◽

Tim Luckett ◽

Mark A. Buhagiar ◽

Sungwon Chang ◽

Jane L. Phillips

Keyword(s):

Systematic Review ◽

Cancer Treatment ◽

Meta Analysis ◽

Risk Of Bias ◽

Middle Income ◽

Considerable Heterogeneity ◽

Secondary Lymphedema ◽

Middle Income Countries ◽

Pooled Prevalence ◽

Arm Lymphedema

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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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Self-Medication with Antibiotics among University Students in LMIC: A systematic review and meta-analysis

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11359 ◽

2019 ◽

Vol 13 (08) ◽

pp. 678-689 ◽

Cited By ~ 1

Author(s):

Rixiang Xu ◽

Tingyu Mu ◽

Guan Wang ◽

Jing Shi ◽

Xin Wang ◽

...

Keyword(s):

Systematic Review ◽

University Students ◽

Meta Analysis ◽

Antibiotic Use ◽

Self Medication ◽

Middle Income ◽

Inappropriate Use ◽

Middle Income Countries ◽

Effective Interventions ◽

Pooled Prevalence

Introduction: Self-medication with antibiotics (SMA) is common among university students in low and middle-income countries (LMICs). However, there has been no meta-analysis and systematic review in the population. Methodology: A literature search was conducted using PubMed, Embase and Web of Science for the period from January 2000 to July 2018. Only observational studies that had SMA among university students from LMICs were included. A random-effects model was applied to calculate the pooled effect size with 95% confidence interval (CI) due to the expected heterogeneity (I2 over 50%). Results: The pooled prevalence of SMA of overall included studies was 46.0% (95% CI: 40.3% to 51.8%). Africa had the highest pooled prevalence of SMA among university students (55.30%), whereas South America had the lowest prevalence (38.3%). Among individual LMICs, the prevalence of SMA among university students varied from as low as 11.1% in Brazil to 90.7% in Congo. Conclusions: The practice of SMA is a widespread phenomenon among university students in LMICs and is frequently associated with inappropriate use. Effective interventions such as medication education and stricter governmental regulation concerning antibiotic use and sale are required to be established in order to deal with SMA properly.

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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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Does a phone text message improve focused antenatal care visit and skill birth attendance in low and middle income countries? A systematic review and meta-analysis of randomized clinical trials (Preprint)

10.2196/preprints.10325 ◽

2018 ◽

Author(s):

Fasil Wagnew ◽

Getenet Ayalew Dessie1 ◽

Animut Ayalew Alebel ◽

Henok Teshome Mulugeta ◽

Amanuel Abajobir Alemu

Keyword(s):

Systematic Review ◽

Text Messaging ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Skilled Birth Attendance ◽

Risk Of Bias ◽

Middle Income ◽

Middle Income Countries ◽

Birth Attendance ◽

Focused Antenatal Care

BACKGROUND Background: Missed appointments are a major cause of inefficiency in healthcare delivery. MHealth has been projected as a possible solution to support women during pregnancy, birth and puerperium period, to increase the uptake of essential maternal services. OBJECTIVE This systematic review and meta-analysis study was aimed to determine the effectiveness of phone text messaging on Focused Antenatal Care (FANC) visits and skilled birth attendance in Low and Middle Income Countries (LMICs). METHODS We searched a broad body of literature from electronic databases–Cochrane review, PsycINFO, PubMed and Google Scholar to offer comprehensive evidence on the role of phone text messaging on FANC visits and skilled birth attendance. We extracted data from only randomized clinical trials (RCTs). Meta-analyses were conducted using random-effects models with inverse variance method in Review Manager (RevMan) computer software. Qualities of the included studies were determined by GRADEpro, and risk of bias was assessed using Cochrane Collaboration risk of bias tool. RESULTS Result: Of the 1,224 non-duplicated articles screened, only 7 RCT studies met eligibility criteria and included in this synthesis. On aggregate, there were statistically significant associations in experimental group in that pregnant mothers who received text messaging had a 74% increase in FANC visits (OR = 2.74 (95% CI: 1.41, 5.32) and 82% in skilled birth attendance (OR = 1.82 (95% CI: 1.33, 2.49). The overall qualities of included studies were moderate, and had low risk of bias. CONCLUSIONS Conclusion: Phone text messaging has positive effects for the uptake of FANC visits and skill birth attendance in LMICs. A short messaging service targeting pregnant woman is an invaluable, affordable intervention to improve maternal healthcare seeking behaviors. CLINICALTRIAL Not applicable

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Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies

Journal of Comorbidity ◽

10.1177/2235042x19870934 ◽

2019 ◽

Vol 9 ◽

pp. 2235042X1987093 ◽

Cited By ~ 28

Author(s):

Hai Nguyen ◽

Gergana Manolova ◽

Christina Daskalopoulou ◽

Silia Vitoratou ◽

Martin Prince ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries ◽

Final Sample ◽

Pooled Prevalence ◽

Gender And Age ◽

Resources Distribution ◽

Newcastle Ottawa Scale

Background: With ageing world populations, multimorbidity (presence of two or more chronic diseases in the same individual) becomes a major concern in public health. Although multimorbidity is associated with age, its prevalence varies. This systematic review aimed to summarise and meta-analyse the prevalence of multimorbidity in high, low- and middle-income countries (HICs and LMICs). Methods: Studies were identified by searching electronic databases (Medline, Embase, PsycINFO, Global Health, Web of Science and Cochrane Library). The term ‘multimorbidity’ and its various spellings were used, alongside ‘prevalence’ or ‘epidemiology’. Quality assessment employed the Newcastle-Ottawa scale. Overall and stratified analyses according to multimorbidity operational definitions, HICs/LMICs status, gender and age were performed. A random-effects model for meta-analysis was used. Results: Seventy community-based studies (conducted in 18 HICs and 31 LMICs) were included in the final sample. Sample sizes ranged from 264 to 162,464. The overall pooled prevalence of multimorbidity was 33.1% (95% confidence interval (CI): 30.0–36.3%). There was a considerable difference in the pooled estimates between HICs and LMICs, with prevalence being 37.9% (95% CI: 32.5–43.4%) and 29.7% (26.4–33.0%), respectively. Heterogeneity across studies was high for both overall and stratified analyses ( I 2 > 99%). A sensitivity analysis showed that none of the reviewed studies skewed the overall pooled estimates. Conclusion: A large proportion of the global population, especially those aged 65+, is affected by multimorbidity. To allow accurate estimations of disease burden, and effective disease management and resources distribution, a standardised operationalisation of multimorbidity is needed.

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Metabolic syndrome among children and adolescents in low and middle income countries: a systematic review and meta-analysis

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-020-00601-8 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Zebenay Workneh Bitew ◽

Ayinalem Alemu ◽

Ermias Getaneh Ayele ◽

Zelalem Tenaw ◽

Anmut Alebel ◽

...

Keyword(s):

Systematic Review ◽

Metabolic Syndrome ◽

General Population ◽

Children And Adolescents ◽

Meta Analysis ◽

Middle Income ◽

Middle Income Countries ◽

Pooled Prevalence ◽

Obese Population ◽

Low And Middle Income

Abstract Background Metabolic syndrome (MetS) is a clustering of cardiovascular risk factors, which is rising in the low and middle income countries (LMICs). There are various studies with inconsistent findings that are inconclusive for policy makers and program planners. Thus, this systematic review and meta-analysis aimed at estimating the pooled prevalence of MetS and its components in LMICs. Methods Electronic searches were conducted in international databases including PubMed, Web of Science, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), Science direct (Elsevier), Food Science and Technology Abstracts (FSTA), Global Health and Medline, and other sources (World Cat, Google Scholar, and Google). The pooled estimates were computed in the random effect model. The pooled prevalence was computed using the three diagnostic methods (IDF, ATP III and de Ferranti). Publication bias was verified using funnel plot and Egger’s regression test. Subgroup and sensitivity analysis were performed to identify the possible sources of heterogeneity among the included studies. Result In this study, 142,142 children and adolescents from 76 eligible articles were included to compute the pooled prevalence of MetS and its components in LMCIs. MeTs among overweight and obese population was computed from 20 articles with the pooled prevalence of 24.09%, 36.5%, and 56.32% in IDF, ATP III and de Ferranti criteria, respectively. Similarly, a total of 56 articles were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, Mets was found in 3.98% (IDF), 6.71% (ATP III) and 8.91% (de Ferranti) of study subjects. Regarding the components of MetS, abdominal obesity was the major component in overweight and obese population and low HDL-C was the most common component in the general population. This study also revealed that males were highly affected by MetS than females. Conclusion This study illustrates that MetS among children and adolescents is an emerging public health challenge in LMICs, where the prevalence of obesity is on the move. Preventive strategies such as community and school based intervention need to be designed. Promoting physical activities and healthy eating behaviors could avert this problem.

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The prevalence of depression symptoms among infertile women: a systematic review and meta-analysis

Fertility Research and Practice ◽

10.1186/s40738-021-00098-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Zahra Kiani ◽

Masoumeh Simbar ◽

Sepideh Hajian ◽

Farid Zayeri

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Depression Symptoms ◽

Middle Income ◽

Infertile Women ◽

Middle Income Countries ◽

Pooled Prevalence ◽

Prevalence Of Depression ◽

Low And Middle Income

Abstract Background Infertile women’s mental health problems, including depression, are key fertility health issues that affect infertile women more severely than infertile men. Depression may threaten the health of individuals and reduce the quality of their lives. Considering the role and impact of depression on responses to infertility treatments, a systematic review and meta-analysis were conducted to investigate the prevalence of depression symptoms among infertile women. Methods International databases (PubMed, Cochrane Library, Web of Sciences, Scopus, Embase, and PsycINFO), national databases (SID and Magiran), and Google Scholar were searched by two independent reviewers for articles published from 2000 to April 5, 2020. The search procedure was performed in both Persian and English using keywords such as “depression,” “disorders,” “infertility,” “prevalence,” and “epidemiology.” The articles were evaluated in terms of their titles, abstracts, and full texts. The reviewers evaluated the quality of the articles using the Newcastle–Ottawa Scale, after which they analyzed the findings using STATA version 14. The I2 and Egger’s tests were performed to examine heterogeneity and publication bias, respectively. Results Thirty-two articles were subjected to the meta-analysis, and a random effects model was used in the examination given the heterogeneity of the articles. The samples in the reviewed studies encompassed a total of 9679 infertile women. The lowest and highest pooled prevalence rates were 21.01% (95% confidence interval [CI]: 15.61–34.42), as determined using the Hospital Anxiety and Depression Scale, and 52.21% (95% CI: 43.51–60.91), as ascertained using the Beck Depression Inventory, respectively. The pooled prevalence values of depression among infertile women were 44.32% (95% CI: 35.65–52.99) in low- and middle-income countries and 28.03% (95% CI: 19.61–36.44) in high-income countries. Conclusion The prevalence of depression among infertile women was higher than that among the general population of a given country. Especially in low- and middle-income countries, appropriate measures, planning, and policy that target the negative effects of depression on infertile women’s lives should be established to reduce related problems.

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Effectiveness of technological interventions to improve upper limb motor function in people with stroke in low- and middle-income countries: Protocol for a systematic review and meta-analysis

10.1101/2020.11.10.20209197 ◽

2020 ◽

Author(s):

Meiling Milagros Carbajal-Galarza ◽

Nathaly Olga Chinchihualpa-Paredes ◽

Sergio Alejandro Abanto-Perez ◽

María Lazo-Porras

Keyword(s):

Systematic Review ◽

Upper Extremity ◽

Motor Function ◽

Upper Limb ◽

Meta Analysis ◽

Risk Of Bias ◽

Middle Income ◽

Middle Income Countries ◽

Technological Interventions ◽

Low And Middle Income

ABSTRACTIntroductionStroke is one of the main causes of disability in low- and middle-income countries (LMIC), frequently presenting with upper extremity paresis and causing major functional dependence. It requires high dose and intense rehabilitation which implies high economic costs, consequently limiting this therapy in LMIC. There are multiple technological interventions that facilitate rehabilitation either in intensity, adherence and motor evaluation; or enable access to rehabilitation such as robots, games or virtual reality, sensors, electronic devices and tele-rehabilitation. Their efficacy has been mainly evaluated in high-income countries, hence the importance of conducting a systematic review in LMIC settings.ObjectivesTo measure the efficacy of technological interventions vs. classical physical rehabilitation in the upper extremity motor function in people who had suffered a first or recurrent episode of stroke in LMIC.Methods and analysisThis protocol is consistent with the methodology recommended by the PRISMA-P and the Cochrane handbook for systematic reviews of interventions. We propose to do a systematic review and meta-analysis. In order to do so, we will perform an electronic search in PubMed, Global Index Medicus and Physiotherapy Evidence Database. No date range parameters will be used. Randomized controlled trials (RCT) published in English, Spanish, French and Portuguese, with the primary outcome focusing on upper limb motor function, will be included. Two reviewers will screen all retrieved titles, abstracts and full texts, perform the evaluation of the risk of bias and extract all data independently. The risk of bias of the included RCT will be evaluated by the Cochrane Collaboration’s tool. A qualitative synthesis will be provided in text and tables, to summarize the main results of the selected publications.The heterogeneity between studies will be assessed through the I2 statistic. If there is sufficient homogeneity across outcomes, a meta-analysis will be considered. The outcomes to be evaluated will be motor functionality of the upper extremity, performance for activities of daily living and quality of life, through measurement scales.ConclusionsThis systematic review will provide evidence regarding the efficacy of multiple technological interventions to improve motor function of upper extremity in individuals with stroke in LMIC. Based on this analysis, we will be able to assess whether these interventions are also effective and feasible in the recovery of functionality after stroke in low- and middle-income countries, and thus offer recommendations in these areas.

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Financial toxicity of cancer care in low and middle-income countries: a systematic review and meta-analysis

10.21203/rs.3.rs-161170/v1 ◽

2021 ◽

Author(s):

Andrew Donkor ◽

Vivian Della Atuwo-Ampoh ◽

Frederick Yakanu ◽

Eric Torgbenu ◽

Edward Kwabena Ameyaw ◽

...

Keyword(s):

Systematic Review ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Meta Analysis ◽

Cost Of Care ◽

Financial Toxicity ◽

Middle Income ◽

Middle Income Countries ◽

Pooled Prevalence ◽

Low And Middle Income

Abstract Introduction: The costs associated with cancer diagnosis, treatment and care present enormous financial toxicity. However, evidence of financial toxicity associated with cancer in low and middle-income countries (LMICs) is scarce.Aim: To identify the extent of cancer-related financial toxicity and how it has been measured in LMICs.Methods: Four electronic databases were searched to identify studies of any design that reported financial toxicity among cancer patients in LMICs. Random-effects meta-analysis was used to derive the pooled prevalence of financial toxicity. Sub-group analyses were performed according to: costs; and determinants of financial toxicity.Results: A total of 31 studies were included in this systematic review and meta-analysis. The pooled prevalence of financial toxicity was 56.96% [95% CI, 30.51, 106.32]. In sub-group meta-analyses, the financial toxicity was higher among cancer patients with household size of more than four (1.17% [95% CI, 1.03, 1.32]; p = 0.02; I2 = 0%), multiple cycles of chemotherapy (1.94% [95% CI, 1.00, 3.75]; p = 0.05; I2 = 43%) and private health facilities (2.87% [95% CI, 1.89, 4.35]; p < 0.00001; I2 = 26%). Mean medical costs per cancer patients were $2,740.18 [95% CI, $1,953.62, $3,526.74]. The ratio of cost of care to gross domestic product (GDP) per capita varied considerably across the LMICs included in this review, which ranged from 0.06 in Vietnam to 327.65 in Ethiopia.Conclusions: This study indicates that cancer diagnosis, treatment and care impose high financial toxicity on cancer patients in LMICs. Further rigorous research on cancer-related financial toxicity is needed.

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