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)

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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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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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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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/v1 ◽

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

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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Does involving male partners in antenatal care improve healthcare utilisation? Systematic review and meta-analysis of the published literature from low- and middle-income countries

International Health ◽

10.1093/inthealth/ihz073 ◽

2019 ◽

Vol 12 (5) ◽

pp. 484-498 ◽

Cited By ~ 1

Author(s):

Dedih Suandi ◽

Pauline Williams ◽

Sohinee Bhattacharya

Keyword(s):

Systematic Review ◽

Antenatal Care ◽

Positive Impact ◽

Meta Analysis ◽

Male Partner ◽

Maternal And Newborn Health ◽

Middle Income ◽

Middle Income Countries ◽

Birth Attendance ◽

Low And Middle Income

Abstract Background Although in most low- and middle-income countries (LMICs) men are decision makers and control the household budget, their involvement in maternity care is limited. Reports from high-income countries indicate a beneficial effect of involving men in antenatal and delivery care on birth outcomes. Methods We conducted a systematic review to assess whether similar effects are observed in LMICs. We searched MEDLINE, PubMed, CINAHL, Embase, NCBI, PsycInfo and other relevant databases using a comprehensive search strategy to retrieve relevant articles. A total of 17 articles were included. Meta-analysis of extracted data was performed, using the generic inverse variance method where possible. All studies were conducted in South Asia and Africa. Results We found that involving a male partner in antenatal care was associated with skilled birth attendance utilization (pooled OR 3.19 [95% CI 1.55 to 6.55]), having institutional delivery (OR 2.76 [95% CI 1.70 to 4.50]) and post-partum visit uptake (OR 2.13 [95% CI 1.45 to 3.13]). Mother’s knowledge of danger signs and modern contraception utilization were also positively affected. However, it had no significant impact on the number of antenatal visits. Conclusions Male involvement in antenatal care had a positive impact on the uptake of maternal health services. Further research needs to investigate whether this translates into improved maternal and newborn health in developing countries.

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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

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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