A Systematic Review and Meta-Analysis of Burnout Among Healthcare Workers During COVID-19

Burnout among healthcare personnel has been exacerbated by the COVID-19 pandemic's unique features. During the COVID-19 pandemic, this systematic review and meta-analysis aims to provide a complete assessment of the prevalence of burnout across various healthcare personnel. Until January 2021, systematic searches for English language papers were conducted using PubMed, Scopus, EMBASE, Web of Science, Cochrane Library, and ProQuest. Thirty observational studies were found after conducting systematic searches. The pooled overall prevalence of burnout was 52% [95% confidence interval (CI) 40–63%]. Pooled emotional exhaustion (EE), depersonalization (DP), and lack of personal accomplishment (PA) were 51% (95% CI 42–61%), 52% (95% CI 39–65%), and 28% (95% CI 25–31%), respectively. This study demonstrated that nearly half of the healthcare workers experienced burnout during the COVID-19 pandemic. In the studies that were included, non-frontline COVID-19 exposed healthcare personnel also experienced burnout. From high to lower middle-income countries, there was a gradient in the prevalence of total burnout, EE, and lack of PA. Further studies on burnout in low and lower-middle-income countries are suggested. A uniform diagnostic tool for the assessment of burnout is warranted.

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Seroprevalence of SARS CoV-2 infection in Low and Middle-Income Countries and risk classification in the context of rolling out vaccine candidate across these countries : Protocol for a systematic review and meta-analysis

10.21203/rs.3.rs-578481/v1 ◽

2021 ◽

Author(s):

Martin Ackah ◽

Louise Ameyaw ◽

Kwadwo Owusu Akuffo ◽

Cynthia Osei Yeboah ◽

Nana Esi Wood ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Vaccine Candidate ◽

Meta Analysis ◽

Cochrane Library ◽

Research Database ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Low And Middle Income

Abstract Background Seroprevalence of SARS Cov-2 provides a good indication of the extent of exposure and spread in the population, as well as those likely to benefit from a vaccine candidate. To date, there is no published or ongoing systematic review on the seroprevalence of COVID-19 in Low- and Middle-Income Countries (LMICs). This systematic review and meta-analysis will estimate SARS Cov-2 seroprevalence and the risk factors for SARS Cov-2 infection in LMICs.Methods We will search PubMed, EMBASE, WHO COVID-19 Global research database, Google Scholar, the African Journals Online, LILAC, HINARI, medRxiv, bioRxiv and Cochrane Library for potentially useful studies on seroprevalence of COVID-19 in LMICs from December 2019 to December 2020 without language restriction. Two authors will independently screen all the articles, select studies based on pre-specified eligibility criteria and extract data using a pre-tested data extraction form. Any disagreements will be resolved through discussion between the authors. The pooled seroprevalence of SARS CoV-2 for people from LMICs will be calculated. Random effects model will be used in case of substantial heterogeneity in the included studies, otherwise fixed-effect model will be used. A planned subgroup, sensitivity and meta-regression analyses will be performed. For comparative studies, the analyses will be performed using Review Manager v 5.4; otherwise, STATA 16 will be used. All effect estimates will be presented with their confidence intervals.Discussion The study will explore and systematically review empirical evidence on SARS Cov-2 seroprevalence in LMICs, and to assess the risk factors for SARS Cov-2 infection in Low Middle Income Countries in the context of rolling out vaccines in these countries. Finally, explore risk classifications to help with the rolling out of vaccines in LMICs.Systematic review registration: The protocol for this review has been registered in PROSPERO (CRD422020221548).

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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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Duration of palliative care before death in international routine practice: a systematic review and meta-analysis

BMC Medicine ◽

10.1186/s12916-020-01829-x ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Roberta I. Jordan ◽

Matthew J. Allsop ◽

Yousuf ElMokhallalati ◽

Catriona E. Jackson ◽

Helen L. Edwards ◽

...

Keyword(s):

Systematic Review ◽

Palliative Care ◽

English Language ◽

Meta Analysis ◽

Service Evaluation ◽

Research Literature ◽

Cochrane Library ◽

Routine Practice ◽

Middle Income ◽

Palliative Care Services

Abstract Background Early provision of palliative care, at least 3–4 months before death, can improve patient quality of life and reduce burdensome treatments and financial costs. However, there is wide variation in the duration of palliative care received before death reported across the research literature. This study aims to determine the duration of time from initiation of palliative care to death for adults receiving palliative care across the international literature. Methods We conducted a systematic review and meta-analysis that was registered with PROSPERO (CRD42018094718). Six databases were searched for articles published between Jan 1, 2013, and Dec 31, 2018: MEDLINE, Embase, CINAHL, Global Health, Web of Science and The Cochrane Library, as well undertaking citation list searches. Following PRISMA guidelines, articles were screened using inclusion (any study design reporting duration from initiation to death in adults palliative care services) and exclusion (paediatric/non-English language studies, trials influencing the timing of palliative care) criteria. Quality appraisal was completed using Hawker’s criteria and the main outcome was the duration of palliative care (median/mean days from initiation to death). Results One hundred sixty-nine studies from 23 countries were included, involving 11,996,479 patients. Prior to death, the median duration from initiation of palliative care to death was 18.9 days (IQR 0.1), weighted by the number of participants. Significant differences between duration were found by disease type (15 days for cancer vs 6 days for non-cancer conditions), service type (19 days for specialist palliative care unit, 20 days for community/home care, and 6 days for general hospital ward) and development index of countries (18.91 days for very high development vs 34 days for all other levels of development). Forty-three per cent of studies were rated as ‘good’ quality. Limitations include a preponderance of data from high-income countries, with unclear implications for low- and middle-income countries. Conclusions Duration of palliative care is much shorter than the 3–4 months of input by a multidisciplinary team necessary in order for the full benefits of palliative care to be realised. Furthermore, the findings highlight inequity in access across patient, service and country characteristics. We welcome more consistent terminology and methodology in the assessment of duration of palliative care from all countries, alongside increased reporting from less-developed settings, to inform benchmarking, service evaluation and quality improvement.

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Lower Income Levels Correlate With Increased Prevalence of Gestational Diabetes Mellitus: A Systematic Review and Network Meta-Analysis

10.21203/rs.3.rs-139122/v1 ◽

2021 ◽

Author(s):

Qiong He ◽

Mengyuan Zhang ◽

Yongle Wang ◽

Jin Zhang ◽

Yi Zhang ◽

...

Keyword(s):

Systematic Review ◽

Gestational Diabetes ◽

Low Income ◽

Web Of Science ◽

Meta Analysis ◽

Income Level ◽

Cochrane Library ◽

Lower Income ◽

Middle Income ◽

Income Levels

Abstract BackgroundIncome level is an important factor that influences the occurrence of gestational diabetes. Thus, this systematic review and network meta-analysis aimed at evaluating the correlation between income levels and the prevalence of gestational diabetes. MethodsRelevant published studies were searched in Pubmed, Web of Science, Cochrane library, and Ovid from the establishment time of database to January 3, 2020. Finally, 13 eligible clinical studies involving 1,817,801 women were selected from a total of 3776 studies and included in this study. The statistical softwares Revman5.3 and Stata14.0 were used to compare the prevalence of gestational diabetes in five different income levels; low, lower middle, medium, upper middle, and high. ResultsThe incidences of gestational diabetes in people with different economic income levels were: high income <middle income <upper middle income <lower middle income <low income. ConclusionThere is no linear correlation between income levels and incidences of gestational diabetes. However, the overall prevalence of gestational diabetes is inversely proportional to income level, that is, the higher the income level, the lower the prevalence of gestational diabetes.

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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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Effectiveness of interventions for improving timely diagnosis of breast and cervical cancers in low and middle-income countries: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-042788 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042788

Author(s):

Chukwudi Arnest Nnaji ◽

Paul Kuodi ◽

Fiona M Walter ◽

Jennifer Moodley

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Cochrane Library ◽

Middle Income ◽

Cervical Cancers ◽

Middle Income Countries ◽

Timely Diagnosis ◽

Evidence Summary ◽

Low And Middle Income

IntroductionBreast and cervical cancers pose a major public health burden globally, with disproportionately high incidence, morbidity and mortality in low- and middle-income countries (LMICs). The majority of women diagnosed with cancer in LMICs present with late-stage disease, the treatment of which is often costlier and less effective. While interventions to improve the timely diagnosis of these cancers are increasingly being implemented in LMICs, there is uncertainty about their role and effectiveness. The aim of this review is to systematically synthesise available evidence on the nature and effectiveness of interventions for improving timely diagnosis of breast and cervical cancers in LMICs.Methods and analysisA comprehensive search of published and relevant grey literature will be conducted. The following electronic databases will be searched: MEDLINE (via PubMed), Cochrane Library, Scopus, CINAHL, Web of Science and the International Clinical Trials Registry Platform (ICTRP). Evidence will be synthesised in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Two reviewers will independently screen the search outputs, select studies using predefined inclusion criteria and assess each included study for risk of bias. If sufficient data are available and studies are comparable in terms of interventions and outcomes, a meta-analysis will be conducted. Where studies are not comparable and a meta-analysis is not appropriate, a narrative synthesis of findings will be reported.Ethics and disseminationAs this will be a systematic review of publicly available data, with no primary data collection, it will not require ethical approval. Findings will be disseminated widely through a peer-reviewed publication and forums such as conferences, workshops and community engagement sessions. This review will provide a user-friendly evidence summary for informing further efforts at developing and implementing interventions for addressing delays in breast and cervical cancer diagnosis in LMICs.PROSPERO registration numberCRD42020177232.

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Covid-19 Infection, Illness and Deaths Among Healthcare Workers in Low- and Middle-Income Countries: A Systematic Review Protocol

10.21203/rs.3.rs-215109/v2 ◽

2021 ◽

Author(s):

Moses Ocan ◽

Brenda Allen Kawala ◽

Ephraim Kisangala ◽

Regina Ndagire ◽

Rachel Nante Wangi ◽

...

Keyword(s):

Systematic Review ◽

Healthcare Workers ◽

Low Cost ◽

Evidence Synthesis ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries ◽

Mesh Terms ◽

The Impact ◽

Low And Middle Income

Abstract Background: Globally, health care workers continue to be infected, fall ill and die at the frontline of the Coronavirus disease 2019 (COVID-19) fight, an indicator of inadequate safety in health facilities. This rapid evidence synthesis aims to highlight the impacts of COVID-19 on healthcare workers in low-and middle-income countries (LMICs) in terms of infections, illnesses and deaths. Methods: A systematic review will be done. Article search will be performed by an experienced librarian in PubMed, MEDLINE Ovid, Google Scholar, COVID-END, Cochrane library and targeted search from other relevant sources. MeSH terms and Boolean operators “AND” and “OR” will be used in the article search. Independent reviewers will screen the retrieved articles using a priori criteria. Data abstraction will be done using an excel based abstraction tool and synthesized using structured narratives and summary of findings tables. Discussion and anticipated use of results: This evidence synthesis seeks to analyze the impact of COVID-19 on the healthcare systems of low- and middle-income countries. Information on healthcare worker infections, illness, and deaths due to COVID-19, will be collated from published research articles. This will help guide decision makers in establishing low- cost high impact interventions to mitigate the effects of COVID-19 in the health work force.Protocol registration: PROSPERO CRD 42020204174

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Cost and Cost-effectiveness of eLearning Interventions for Healthcare Workers in Low- and Middle-income Countries: a Protocol for a Systematic Review and Meta-analysis

10.21203/rs.3.rs-951427/v1 ◽

2021 ◽

Author(s):

Nonjabulo Gwala ◽

Thembelihle Patricia Dlungwane ◽

Sphamandla Nkambule ◽

Tivani Mashamba-Thompson

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Healthcare Workers ◽

Professional Training ◽

Meta Analysis ◽

Middle Income ◽

Worker Training ◽

Middle Income Countries ◽

The Cost ◽

Low And Middle Income

Abstract BackgroundIn recent years, the shift from traditional face-to-face teaching methods to eLearning methods has shown to improve professional training, particularly for the health workers in achieving necessary specialised worker training. However, there is a insufficient evidence on the costs and cost-effectiveness of designing and deploying eLearning interventions for healthcare workers in low- and middle-income countries.MethodsThe study protocol was developed and reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The Cochrane Handbook for Systematic Reviews of Interventions will be used to guide the conduct of the proposed systematic review and meta-analysis. Systematic literature searches will be conducted using the EBSCOhost platform ( Academic Search Complete, ERIC, health source: nursing/academic edition, MEDLINE with Full Text, OpenDissertations), Google Scholar, and the following databases: Web of Science, PubMed and ProQuest databases, evaluating the cost and cost-effectiveness of e-learning interventions for healthcare workers in low- and middle-income countries. The searches will be open to peer-reviewed articles published in all languages and no restriction in publication year. We will further evaluate the cost-effectiveness by determining heterogeneity in the content, if feasible we will do a meta-analysis using Meta- Easy Excel software tools. We will use OR and 95% CIs as measures of effect for dichotomous outcomes. As for continuous outcomes, we will use standardised mean differences and 95% CIs. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to assess the certainty of the evidence across outcomes. PRISMA-P will be used to report the findings of this systematic review and meta-analysis.DiscussionThis systematic review target to deliver complete evidence of cost and the cost-effectiveness of eLearning interventions for healthcare worker training. The study will be disseminated through the publication of the manuscript and policy brief in an appropriate journal and shared with the relevant stakeholders through conference presentations, discussions and seminars.Protocol registrationPROSPERO ID: 271180

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Safe 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/v2 ◽

2020 ◽

Author(s):

Negasa Eshete Soboksa ◽

Beekam Kebede Olkeba ◽

Dinkinesh Begna Gudeta

Keyword(s):

Systematic Review ◽

Low Income ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Secondary Outcome ◽

Childhood Diarrhea ◽

Middle Income ◽

Middle Income Countries ◽

Google Search

Abstract Introduction: In household environments, the improper handling of children's feces can be a significant contaminant, raising a high risk of baby exposure. Several studies done on the magnitude of safe disposal of child feces and its association with reported childhood diarrhea have varied outcomes and no tries have been made to systematically review this. Therefore, a systematic review is necessary to provide an exhaustive summary of the current evidence. Thus, the objective of this a systematic review and meta-analysis will be to pool out the available evidence on the magnitude of safe child feces disposal practices and its association with reported childhood diarrhea in low-income and middle-income countries. Methods: In order to find applicable literature for this study, PubMed, Science Direct, the Cochrane Library collection and Ovid Medline will be searched. In addition, it can search for Google Search Engine, Google Scholar, and references from other studies.The primary outcome of interest will be the magnitude of safe child feces disposal practices and the secondary outcome will be its association with reported diarrhea. Observational studies (cross-sectional studies, case-control studies, and cohort studies) written in English, from January 2000 onwards will be included. The selected studies will be critically appraised by two independent reviewers using an appropriate tool. The pooled magnitude of safe child feces disposal practices 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 the magnitude of safe child feces disposal practices and its association with reported diarrhea. The findings from this study will be made 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 preventing childhood diarrhea in the community.Systematic review registration number: PROSPERO CRD42020189034

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Covid-19 Infection, Illness and Deaths Among Healthcare Workers in Low- and Middle-income Countries: A Systematic Review Protocol

10.21203/rs.3.rs-215109/v1 ◽

2021 ◽

Author(s):

Moses Ocan ◽

Brenda Allen Kawala ◽

Ephraim Kisangala ◽

Regina Ndagire ◽

Rachel Nante Nante Wangi ◽

...

Keyword(s):

Systematic Review ◽

Healthcare Workers ◽

Evidence Synthesis ◽

Cochrane Library ◽

Middle Income ◽

Middle Income Countries ◽

Mesh Terms ◽

Protocol Registration ◽

The Impact ◽

Low And Middle Income

Abstract Background: Globally, health care workers continue to be infected, fall ill and die at the frontline of the Coronavirus Disease 2019 (COVID-19) fight, an indicator of inadequate safety in health facilities. This rapid evidence synthesis aims to highlight the impacts of COVID-19 on healthcare workers in low-and middle-income countries (LMICs) in terms of infections, illnesses and deaths. Methods: A systematic review will be done. Article search will be performed by an experienced librarian in PubMed, MEDLINE Ovid, Google Scholar, COVID-END, Cochrane library and targeted search from other relevant sources. MeSH terms and Boolean operators “AND” and “OR” will be used in the article search. Independent reviewers will screen the retrieved articles using a priori criteria. Data abstraction will be done using an excel based abstraction tool and synthesized using structured narratives and summary of findings tables. Discussion: This evidence synthesis seeks to analyze the impact of COVID-19 on the healthcare systems of low- and middle-income countries. Information on healthcare worker infections, illness, and deaths due to COVID-19, will be collated from published research articles. This will help guide decision makers in establishing low- cost high impact interventions to mitigate the effects of COVID-19 in the health work force.Protocol registration: PROSPERO CRD 42020204174 [1] [1] This protocol registration can be found at; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020204174

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