scholarly journals Underreporting of treatment outcomes in hospitalized COVID-19 infected diabetes patients: A systematic review, meta-analysis, and meta-regression

2021 ◽  
Vol 4 (4) ◽  
pp. 573-580
Author(s):  
Sumanta Saha ◽  
Sujata Saha
Keyword(s):  
Treatment Outcome ◽  
Publication Bias ◽  
Meta Analysis ◽  
Case Series ◽  
Outcome Data ◽  
Considerable Proportion ◽  
Publication Date ◽  
Bias Assessment ◽  
Pooled Prevalence ◽  
Diabetes Patients

Background: Prolonged inpatient care requirements and time constraints of research and researchers lead to the non-reporting of the treatment outcome of certain COVID-19 infected diabetes patients in published manuscripts. This study aims to quantify its global burden.  Methods: A search for citations addressing the above outcome ensued chiefly in the PubMed, Embase, and Scopus databases, irrespective of the publication date and geographical region. Recruited studies were critically appraised with the National Heart, Lung, and Blood Institute's tool. Using the random-effects meta-analysis with an exact binomial method and Freeman-Tukey double arcsine transformation, the overall and subgroup-wise weighted pooled prevalence of the missing treatment outcome data was determined. The heterogeneity and publication bias assessment utilized I2 and Chi2 statistics, and funnel plot, and Egger's test, respectively. Results: Ten publications (primarily case series; 70.0%) included in this review sourced data from 6687 COVID-19 infected inpatient diabetes patients from Asia, Australia, Europe, and North America. The global pooled prevalence of missing treatment outcome data among these patients was 33.0% (95% CI: 15.0-53.0%; I2: 99.53%; P of Chi2: <0.001). It was highest in Europe (63%; 95% CI: 61.0-66.0%). Publication bias assessment was not suggestive of any small study effect. Conclusion: A considerable proportion of crucial prognosis information of hospitalized COVID-19 patients with diabetes goes underreported. It increases the risk of biasing the contemporary COVID-19-diabetes literature. The reporting of these data in the post-publication era or postponing the primary publication until the availability of all patients' treatment outcome data, when feasible, is recommended to address this enigma.

scholarly journals Overweight and Obesity Among Adult HIV Infected Peoples Receiving ART in Ethiopia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
pp. 215013272199364
Author(s):  
Robel Hussen Kabthymer ◽  
Solomon Nega Techane ◽  
Temesgen Muche ◽  
Helen Ali Ewune ◽  
Semagn Mekonnen Abate ◽  
...  
Keyword(s):  
Publication Bias ◽  
Addis Ababa ◽  
Data Extraction ◽  
Meta Analysis ◽  
Overweight And Obesity ◽  
Obesity And Overweight ◽  
Pooled Prevalence ◽  
Nutrition And Diet ◽  
Prevalence Of Obesity ◽  
Trim And Fill

Background: Over-nutrition and diet-linked non-communicable morbidities are showing increasing trend overtime. Even if there are different factors that affect the change in BMI other than ART, several authors have reported increases in BMI among PLHIV on treatment that are equal to or surpass the general population. This study is aimed to estimate the prevalence of obesity and overweight among adult HIV infected peoples taking ART in Ethiopia. Method: PubMed, CINAHL, Web of science, global health and Google scholar electronic databases were used to perform a systematic literature search. Two authors independently extracted all the necessary data using a structured data extraction format. Data analysis was done using STATA Version 14. The heterogeneity of the studies was assessed by using I2 test. A random-effects model was used to estimate the pooled prevalence. Publication bias was checked using Funnel plot and Egger’s test. Result: Two thousand seven hundred and fifty-one studies were reviewed and 13 studies fulfilling the inclusion criteria were included in the meta-analysis. The meta-analysis of 13 studies, comprising 4994 participants resulted in pooled prevalence of overweight to be 17.85% (95% CI: 12.22-23.47). Whereas, the pooled prevalence of overweight was found to be 3.90 (95% CI: 2.31-5.49) but after adjusting for publication bias using trim and fill analysis it has become 3.58 (95% CI: 2.04-5.13). Magnitude of both overweight and obesity was higher in studies conducted in Addis Ababa, studies done after 2016 and studies having sample size of less than 400, in subgroup analysis. Conclusion: The magnitude of overweight and obesity among HIV infected peoples taking ART in Ethiopia is high. There is a need to have a routine screening to PLWHA on the risk of over-nutrition in order to facilitate early detection.

scholarly journals Crimean-Congo hemorrhagic fever-induced liver injury: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Sawai Singh Rathore ◽  
Ade Harrison Manju ◽  
Qingqing Wen ◽  
Manush Sondhi ◽  
Reshma Pydi ◽  
...  
Keyword(s):  
Liver Injury ◽  
Case Fatality Rate ◽  
Meta Analysis ◽  
Case Series ◽  
Case Fatality ◽  
Hemorrhagic Fever ◽  
Fatality Rate ◽  
High Case Fatality Rate ◽  
Crimean Congo Hemorrhagic Fever ◽  
Pooled Prevalence

Background: Crimean-Congo hemorrhagic fever (CCHF) is a fatal acute tick-borne viral infection and a substantial emerging global public health threat. This illness has a high case fatality rate of up to 40%. The liver is one of the important target organs of the CCHF virus. Objective: The aim of this meta-analysis to evaluate the correlation between CCHF  and liver injury and draw more generalized inferences about the abnormal serum markers of liver injury such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) in CCHF patients. Methods: A literature search was accomplished for published eligible articles with MEDLINE/PubMed and Embase databases. All eligible observational studies and case series were included from around the world. The inclusion criteria were articles describing liver injury biomarkers AST and ALT amongst patients diagnosed with CCHF. Results: Data from 18 studies, consisting of 1238 patients with CCHF  were included in this meta-analysis. The overall pooled prevalence of at least one raised liver injury biomarker was 77.95% (95% CI, I2 = 88.50%, p < 0.0001). Similarly, pooled prevalence of elevated AST and ALT was 85.92% (95% CI, I2 = 85.27%,  p < 0.0001) and 64.30% (95% CI, I2 = 88.32%,  p < 0.0001) respectively.  Both Egger and Begg-Mazumdar’s tests detected no apparent publication bias in all three meta-analyses(p > 0.05).  Conclusion: These elevated liver injury biomarkers have been identified as significant prognostic factors. Hence, Physicians must recognize and continuously monitor these biomarkers, since these aid early stratification of prognosis and the prevention of severe outcomes in infection with such a high case fatality rate.

scholarly journals Treatment Outcome of Epileptic Patients Receiving Antiepileptic Drugs in Ethiopia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Taklo Simeneh Yazie ◽  
Belayneh Kefale ◽  
Mulugeta Molla
Keyword(s):  
Systematic Review ◽  
Treatment Outcome ◽  
Antiepileptic Drugs ◽  
Addis Ababa ◽  
Meta Analysis ◽  
Age Groups ◽  
Seizure Freedom ◽  
Pharmacoresistant Epilepsy ◽  
Pooled Prevalence ◽  
Epileptic Patients

Background. The prevalence and incidence rate of epilepsy were found to be higher in low- and middle-income countries. Uncontrolled epilepsy has a high risk of disability, stigma, discrimination, human rights violations, and premature death. The available studies of controlled seizure in Ethiopia have showed inconsistent results which calls for systematic review and meta-analysis. Therefore, this review intended to show the pooled prevalence of controlled seizure among people with epilepsy receiving antiepileptic drugs at outpatient department. Methods. A systematic literature search was conducted using PubMed/Medline, Science Direct, PsycINFO, Hinnarri databases, and Google Scholar for grey literatures. Data were extracted with structured format prepared using Microsoft Excel and exported to Stata/MP 16.0 software for analyses. The I 2 test was used to check the heterogeneity between primary studies with a corresponding 95% confidence interval (CI). Results. A total of 23 primary studies were included in the review showing the pooled prevalence of controlled seizure to be 46% (95% CI: 35, 56). A subgroup analysis of the primary studies showed a considerable variation in magnitude of seizure freedom by study regions, age groups, and seizure-free period. The highest prevalence was found in Addis Ababa 52% (95% CI: 29, 75), pediatric patients 77% (95% CI: 71, 83), and a seizure-free period of less than six months 58% (95% CI: 32, 83). On the other hand, the lowest prevalence of controlled seizure was found in Tigray 27% (95% CI: 11, 65), adult patients 43% (95% CI: 32, 54), and a seizure-free period of six or more 41% (95% CI: 32, 51). Higher frequency of seizure before treatment (2.23, 95% CI: 1.15, 3.31) and medication nonadherence (2.7, 95% CI: 1.25, 4.15) had statistically significant association with uncontrolled seizure. Conclusion. In this review, the prevalence of controlled seizure was found to be low. This warrants that clinicians should give more focus to epileptic patients regarding monitoring and evaluation of treatment outcome of epilepsy and factors that affect seizure control in routine clinical services. The use of standardized definition of controlled seizure, designing strategies to identify pharmacoresistant epilepsy and its treatment, and increasing medication adherence are recommended in Ethiopia. The review protocol has been registered with PROSPERO registration number CRD42021215302.

scholarly journals Anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines: a systematic review and meta-analysis

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Saad Alhumaid ◽  
Abbas Al Mutair ◽  
Zainab Al Alawi ◽  
Ali A. Rabaan ◽  
Raghavendra Tirupathi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Case Series ◽  
Incidence Rates ◽  
Effect Sizes ◽  
Cross Sectional ◽  
Randomized Controlled ◽  
Pooled Prevalence ◽  
History Of

Abstract Background Currently there is no systematic review and meta-analysis of the global incidence rates of anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines in the general adult population. Objectives To estimate the incidence rates of anaphylactic and nonanaphylactic reactions after COVID-19 vaccines and describe the demographic and clinical characteristics, triggers, presenting signs and symptoms, treatment and clinical course of confirmed cases. Design A systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] statement was followed. Methods Electronic databases (Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, and Nature) were searched from 1 December 2020 to 31 May 2021 in the English language using the following keywords alone or in combination: anaphylaxis, non-anaphylaxis, anaphylactic reaction, nonanaphylactic reaction, anaphylactic/anaphylactoid shock, hypersensitivity, allergy reaction, allergic reaction, immunology reaction, immunologic reaction, angioedema, loss of consciousness, generalized erythema, urticaria, urticarial rash, cyanosis, grunting, stridor, tachypnoea, wheezing, tachycardia, abdominal pain, diarrhea, nausea, vomiting and tryptase. We included studies in adults of all ages in all healthcare settings. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). To minimize heterogeneity, we performed sub-group analyses. Results Of the 1,734 papers that were identified, 26 articles were included in the systematic review (8 case report, 5 cohort, 4 case series, 2 randomized controlled trial and 1 randomized cross-sectional studies) and 14 articles (1 cohort, 2 case series, 1 randomized controlled trial and 1 randomized cross-sectional studies) were included in meta-analysis. Studies involving 26,337,421 vaccine recipients [Pfizer-BioNTech (n = 14,505,399) and Moderna (n = 11,831,488)] were analyzed. The overall pooled prevalence estimate of anaphylaxis to both vaccines was 5.0 (95% CI 2.9 to 7.2, I2 = 81%, p =  < 0.0001), while the overall pooled prevalence estimate of nonanaphylactic reactions to both vaccines was 53.9 (95% CI 0.0 to 116.1, I2 = 99%, p =  < 0.0001). Vaccination with Pfizer-BioNTech resulted in higher anaphylactic reactions compared to Moderna (8.0, 95% CI 0.0 to 11.3, I2 = 85% versus 2.8, 95% CI 0.0 to 5.7, I2 = 59%). However, lower incidence of nonanaphylactic reactions was associated with Pfizer-BioNTech compared to Moderna (43.9, 95% CI 0.0 to 131.9, I2 = 99% versus 63.8, 95% CI 0.0 to 151.8, I2 = 98%). The funnel plots for possible publication bias for the pooled effect sizes to determine the incidence of anaphylaxis and nonanaphylactic reactions associated with mRNA COVID-19 immunization based on mRNA vaccine type appeared asymmetrical on visual inspection, and Egger’s tests confirmed asymmetry by producing p values < 0.05. Across the included studies, the most commonly identified risk factors for anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines were female sex and personal history of atopy. The key triggers to anaphylactic and nonanaphylactic reactions identified in these studies included foods, medications, stinging insects or jellyfish, contrast media, cosmetics and detergents, household products, and latex. Previous history of anaphylaxis; and comorbidities such as asthma, allergic rhinitis, atopic and contact eczema/dermatitis and psoriasis and cholinergic urticaria were also found to be important. Conclusion The prevalence of COVID-19 mRNA vaccine-associated anaphylaxis is very low; and nonanaphylactic reactions occur at higher rate, however, cutaneous reactions are largely self-limited. Both anaphylactic and nonanaphylactic reactions should not discourage vaccination.

scholarly journals Characteristics of COVID-19 recurrence: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Tung Hoang
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Meta Analysis ◽  
Disease Onset ◽  
Case Series ◽  
Final Analysis ◽  
Disease Recurrence ◽  
Pooled Prevalence ◽  
Epidemiological Characteristics

AbstractBackgroundPrevious studies reported the recurrence of coronavirus disease 2019 (COVID-19) among discharge patients. This study aimed to examine the characteristic of COVID-19 recurrence cases by performing a systematic review and meta-analysis.MethodsA systematic search was performed in PubMed and Embase and gray literature up to September 17, 2020. A random-effects model was applied to obtain the pooled prevalence of disease recurrence among recovered patients and the prevalence of subjects underlying comorbidity among recurrence cases. The other characteristics were calculated based on the summary data of individual studies.ResultsA total of 41 studies were included in the final analysis, we have described the epidemiological characteristics of COVID-19 recurrence cases. Of 3,644 patients recovering from COVID-19 and being discharged, an estimate of 15% (95% CI, 12% to 19%) patients was re-positive with SARS-CoV-2 during the follow-up. This proportion was 14% (95% CI, 11% to 17%) for China and 31% (95% CI, 26% to 37%) for Korea. Among recurrence cases, it was estimated 39% (95% CI, 31% to 48%) subjects underlying at least one comorbidity. The estimates for times from disease onset to admission, from admission to discharge, and from discharge to RNA positive conversion were 4.8, 16.4, and 10.4 days, respectively.ConclusionThis study summarized up-to-date evidence from case reports, case series, and observational studies for the characteristic of COVID-19 recurrence cases after discharge. It is recommended to pay attention to follow-up patients after discharge, even if they have been in quarantine.

scholarly journals Health professional’s job satisfaction and its determinants in Ethiopia: a systematic review and meta-analysis

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Bekahegn Girma ◽  
Jemberu Nigussie ◽  
Alemayehu Molla ◽  
Moges Mareg
Keyword(s):  
Job Satisfaction ◽  
Publication Bias ◽  
Professional Growth ◽  
Meta Analysis ◽  
Random Effect ◽  
Working Environment ◽  
Design Strategies ◽  
Analysis Model ◽  
African Countries ◽  
Pooled Prevalence

Abstract Background Health professional’s job satisfaction is directly related to patient satisfaction and quality of care. Without satisfied health professionals the health system is not functional, and the national and global health related plans are not achieved. However, little is known on the level of health professional’s job satisfaction in sub Saharan African countries including Ethiopia. In addition, in Ethiopia there is no summarized evidence helped us an input to design strategies. Therefore, we aimed to assess the pooled prevalence of health professional’s job satisfaction and its determinants in Ethiopia. Methods Articles were searched from PubMed, PsycINFO, Hinari, Science Direct, web of science and African journal of online (AJOL) databases, Google and Google scholar. A standardized Microsoft excel spread sheet and STATA software version 16 were used for data extraction and analysis respectively. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis to write this report. A random effect meta-analysis model was used to determine the pooled prevalence of job satisfaction. I2 was done to check heterogeneity. Egger’s test and funnel plot were conducted to detect publication bias. Subgroup analysis was also conducted. Association was expressed through pooled odd ratio with a 95% CI. Result In this review and meta-analysis, a total of 29 studies were included. The pooled prevalence of health professional’s job satisfaction was 46.17% [95% CI (43.08, 49.26)]. The heterogeneity and publication bias test results were I2 = 87.3%, P <  0.001 and Eggers’, P = 0.16. Female sex; OR: 2.20 [95% CI (1.63, 2.97)], working environment; OR: 9.50 [95% CI (6.25, 14.44)], opportunity for professional growth and development; OR: 5.53 [95% CI (1.56, 19.56)], staff relationship; OR: 3.89 [95% CI (1.65, 9.17)] and supportive supervision; OR: 5.32 [95% CI (1.77, 15.92)] were associated with health professional’s job satisfaction. Conclusion More than half of professionals were dissatisfied with their jobs. Therefore, the ministry of health and stakeholders better to design strategies to increase the level of satisfaction. Furthermore, it is better to strengthen staff relationship and making the working environment more attractive and equipped.

scholarly journals Lowest wealth quintiles predispose under-five children to stunting in Ethiopia: Updates of systematic review and meta-analysis

2020 ◽  
Author(s):  
Mesfin Wudu Kassaw ◽  
Aschalew Afework ◽  
Alemayehu Digssie ◽  
Netsanet Fentahun ◽  
Murat Açık ◽  
...  
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Meta Analysis ◽  
Public Health Problem ◽  
Wealth Index ◽  
Forest Plot ◽  
Major Public Health Problem ◽  
Under Five ◽  
Under Five Children ◽  
Pooled Prevalence

Abstract Background: Malnutrition remains as a major public health problem in the world, particularly in developing countries such as Ethiopia. The prevalence of stunting in Ethiopia has been decreased considerably from 58% in 2000 to 44% in 2011 and 38% in 2016. The aim of this systematic review and meta-analysis is to assess the prevalence of stunting and its associations with wealth index among under-five children in Ethiopia. Methodology: The databases screened were PubMed/MEDLINE, Scopus, HINARI and grey literatures. The studies’ qualities were assessed by two reviewers independently, and any controversy was handled by other reviewers using the JBI critical appraisal checklist. In the statistical analysis, the funnel plot, Egger’s test, and Begg’s test were used to assess publication bias. The I2 statistic, forest plot, and Cochran’s Q test were used to deal with heterogeneity. Results: The pooled prevalence of stunting was 41.5% among under-five children, despite its considerable heterogeneity (I2=97.6%, p<0.001). However, the included studies had no publication bias in calculating the pooled prevalence (Egger’s test p=0.26; Begg’s test p=0.87). Children from households with a medium or low/poor wealth index had higher odds of stunting (AOR 1.33, 95% CI: 1.07, 1.65 or AOR 1.92, 95% CI: 1.46, 2.54, respectively) compared to children from households with a high/rich wealth index. Conclusions: The pooled prevalence of stunting is great. In the subgroup analysis, the Amhara region, followed by the Oromia region and then the Tigray region had the highest prevalence of stunting

scholarly journals Prevalence of Calf Mortality in Ethiopia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Ephrem Tora ◽  
Mesfin Shrube ◽  
Tamirat Kaba ◽  
Wasihun Seyoum
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Dairy Industry ◽  
Economic Losses ◽  
Original Research ◽  
Pooled Prevalence ◽  
Wide Range ◽  
Calf Mortality

Background. Calf mortality has been a major cause of economic losses in the dairy industry in Ethiopia. The condition results in a significant drop in the number of replacing heifers and bulls for sustainable dairy business. Reports on calf mortality with a wide range of prevalence are rising in the country; however, a pooled prevalence of this condition has not been established. Thus, this systematic review and meta-analysis aimed to quantitatively estimate the pooled prevalence of calf mortality in Ethiopia. Methods. Meta-analysis was carried out to obtain the pooled prevalence of calf mortality in Ethiopia. A comprehensive literature search was carried out on PubMed, African Journals Online, CAB, Web of Science Direct, and Google Scholar. Eligible studies were selected based on predefined inclusion and exclusion criteria. Moderators such as the study area, breed of calf, study design, agroecology, and year of study article published were used as a milestone of data extraction. The random-effect model was used to estimate pooled prevalence. Publication bias and the variation in prevalence estimates attributed to heterogeneity were also assessed. Results. Twenty-five original research papers on the prevalence of calf mortality in various parts of Ethiopia were included. The reported prevalence of calf mortality was between 0.9% and 37%. The pooled prevalence of calf mortality in the country was 14.79%, and the pooled calf mortality estimate across studies for the entire period regarding 1991 to 2000, 2001 to 2010, 2011 to 2016, and 2017 to 2020 was 26.54%, 17.03%, 14.21%, and 11.23%, respectively. Analysis of study subgroups and location revealed significant variations in prevalence. High heterogeneity was observed in the pooled estimates and even after the subgroup meta-analysis. The funnel plots and Egger’s regression asymmetry coefficient (b = −1.0434) (95% CI = −1.49, −0.59; p value of 0.012) did suggest the presence of publication bias. There was also an indication of missing studies that could be incorporated by Duval and Tweedie’s trim and fill method where they might fall on a funnel plot and visualize them in an attempt to increase the plot’s symmetry. Analyses also suggest that calf breed, sample size, and study location are likely to be moderators of calf mortality prevalence in Ethiopia. Conclusion. This finding shows that calf mortality is widespread and could result in considerable economic losses for the dairy industry in Ethiopia. Inevitably, a significant reduction in calf mortality prevalence has been observed in recent years since 2010, but the reduction has not yet reached an economically tolerable level. Calf breed susceptibility contributed to the high prevalence. Therefore, interventions for increasing calf health and performance should be focused on minimizing calf mortality on farm and animal levels.

scholarly journals Prevalence of khat chewing during pregnancy in Ethiopia: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Berhanu Boru Bifftu
Keyword(s):  
Publication Bias ◽  
Meta Analysis ◽  
Previous History ◽  
Educational Status ◽  
Green Plant ◽  
Chi Square ◽  
Khat Chewing ◽  
Inverse Variance ◽  
Pooled Prevalence ◽  
History Of

Abstract Background Khat (Catha edulis) is a flowering green plant mainly chewed for recreational. Khat chewing is becoming on rising at alarming rate and adversely affects the socio-economic, psycho-social, and physical health including the health of the fetus. Thus, this study aimed to determine the pooled prevalence of khat chewing during pregnancy and its associated factors. Methods Databases: PubMed/Medline, CINAHL, SCOPUS and AJOL were searched. Weighted inverse variance random-effects model was used to calculate the pooled prevalence of depression. Heterogeneity across the studies was assessed by Cochrane chi-square and quantified by I2 statistics test. Funnel plots and Egger’s test were used to determine publication bias. Sensitivity test and subgroup analysis were also performed. Results In this study, a total of 9,915 study participants were included from 22 studies. The pooled prevalence of khat chewing was found to be 20% (95% CI; 14%-27%). Tests of heterogeneity demonstrated evidence of heterogeneity (I2 = 98.46%, p < 0.001). However, the analysis of sensitivity tests and publication bias showed absence of influential study and publication bias [Egger’s test (P = 0.02)]. Factors such as: being Muslim, lower educational status, family history of mental illness, and partner previous history of khat chewing were associated with khat chewing. Conclusion One in five pregnant women has history of khat chewing. Thus, authors’ suggest the need of screening for khat chewing as an integrated part of Antenatal care.

scholarly journals High Prevalence of Hypovitaminosis D in Patients with Low Back Pain: Evidence from Meta-Analysis

2018 ◽  
Vol 1 (21;1) ◽  
pp. E389-E399 ◽  
Author(s):  
Dipika Bansal
Keyword(s):  
Vitamin D ◽  
Sensitivity Analysis ◽  
Low Back Pain ◽  
Back Pain ◽  
Publication Bias ◽  
Meta Analysis ◽  
Hypovitaminosis D ◽  
Low Back ◽  
Pooled Prevalence ◽  
High Prevalence

Background: Emerging evidence suggests an association between vitamin D deficiency and low back pain (LBP). Objective: To pool evidence on the prevalence of hypovitaminosis D in patients with LBP. Study Design: Meta-analysis. Methods: A comprehensive literature search was done in PubMed, Cochrane Database, and Google scholar for observational studies including cohort, cross sectional (CS), and case control (CC) evaluating the prevalence of hypovitaminosis D in LBP patients. The primary outcome assessed was a prevalence of hypovitaminosis D in patients with LBP, presented as weighted pooled prevalence ratio (WPPR) with 95% confidence interval (CI) using the random effects model. Heterogeneity and inconsistency of the measurements were identified through Cochran’s Q statistic and I2 statistic. We also performed sensitivity analysis, publication bias (using funnel plot and Begg’s test), and subgroup analysis. Results: Fourteen studies (6 were CC, 6 CS, and 2 cohort) involving 2602 patients were included in the final analysis. The WPPR (95% CI) of hypovitaminosis D in patients with LBP was found to be 0.72 (0.60–0.83). Marked heterogeneity was observed, median quality score of all studies was 7.5 interquartile range (IQR) (6.2 - 8.7) on a scale of 0 to 11. Sensitivity analysis showed robustness of the results. The WPPR of hypovitaminosis D was lower in CS at 0.60 (0.35–0.85) as compared to CC studies at 0.81 (0.72–0.90) (P < 0.01). The WPPR was lower in men at 0.74 (0.63–0.86) as compared to women at 0.84 (0.78–0.89) (P < 0.01). No publication bias was observed. Limitations: Heterogeneity in the cut off level of vitamin D to classify the included patients as vitamin D deficient. Conclusions: The high prevalence of hypovitaminosis D was observed in patients with LBP. This provides a chance to screen the deficiency and correct it by supplementation, which can be therapeutic adjunct in the management of LBP patients. Key words: Low back pain, hypovitaminosis D, meta-analysis, pooled prevalence, systematic review

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