Investigating Poor Sleep Quality and Associated Factors During the COVID-19 Pandemic: A Population-Based Survey in Bangladesh

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected the sleep quality of individuals, and is a poorly investigated area. This study aimed to investigate the prevalence estimate of poor sleep quality and its associated factors among Bangladeshi residents during the COVID-19 pandemic.Methods: An online cross-sectional survey was carried out from July 20 to August 5, 2020, involving 975 Bangladeshi residents (male: 54.2%; mean age: 26.7 ± 9.4 years; age range: 18–75 years). A self-reported questionnaire was answered by the respondents, covering information on demographic characteristics, perceived physical health status, COVID-19-related factors, COVID-19-induced anxiety assessment, and sleep quality. To assess sleep quality, the Bangla version of the Pittsburgh Sleep Quality Index was used. Logistic regression models were performed to analyze the factors associated with sleep quality.Results: The prevalence estimate of poor sleep quality was 55.1% among the Bangladeshi people during the COVID-19 pandemic. As per the multiple regression analysis, poor sleep quality was significantly higher among respondents who reported female gender, moderate/poor health status, indirect contact with COVID-19 infected patients, decreased household income due to the COVID-19 pandemic, fear of infection, and COVID-19-induced anxiety.Conclusion: Poor sleep quality was slightly prevalent among general people in Bangladesh during the COVID-19 pandemic. The findings indicate an immediate response for this vulnerable group to improve the sleep quality during the public health emergency of COVID-19.

Risk of Venous Thromboembolism in Transgender People Undergoing Hormone Feminizing Therapy: A Prevalence Meta-Analysis and Meta-Regression Study

BackgroundAlthough venous thromboembolism (VTE) is a recognized side effect of some formulations of estrogen therapy, its impact in transgender people remains uncertain. The aim of this study was to define pooled prevalence estimate and correlates of VTE in Assigned Males at Birth (AMAB) trans people undergoing gender affirming hormone therapy.MethodsA thorough search of MEDLINE, COCHRANE LIBRARY, SCOPUS and WEB OF SCIENCE databases was carried out to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effects models and the between-study heterogeneity was assessed by the Cochrane’s Q and I2.ResultsThe eighteen studies included gave information about 11,542 AMAB undergoing gender affirming hormone therapy. The pooled prevalence of VTE was 2% (95%CI:1-3%), with a large heterogeneity (I2 = 89.18%, P<0.0001). Trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimate. At the meta-regression analysis, a higher prevalence of VTE was significantly associated with an older age (S=0.0063; 95%CI:0.0022,0.0104, P=0.0027) and a longer length of estrogen therapy (S=0.0011; 95%CI:0.0006,0.0016, P<0.0001). When, according to the meta-regression results, the analysis was restricted to series with a mean age ≥37.5 years, the prevalence estimate for VTE increased up to 3% (95%CI:0-5%), but with persistence of a large heterogeneity (I2 = 88,2%, P<0.0001); studies on younger participants (<37.5 years) collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-2%) with no heterogeneity (I2 = 0%, P=0.97). Prevalence estimate for VTE in series with a mean length of estrogen therapy ≥53 months was 1% (95%CI:0-3%), with persistent significant heterogeneity (I2 = 84,8%, P=0.0006); studies on participants subjected to a shorter length of estrogen therapy (<53 months), collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-3%) with no heterogeneity (I2 = 0%, P=0.76).ConclusionsThe overall rate of VTE in AMAB trans people undergoing gender affirming hormone therapy was 2%. In AMAB population with <37.5 years undergoing estrogen therapy for less than 53 months, the risk of VTE appears to be negligible. Further studies are warranted to assess whether different types and administration routes of estrogen therapy could decrease the VTE risk in AMAB trans people over 37.5 years subjected to long-term therapy.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021229916].

Prevalence of dental caries in Pakistan: a systematic review and meta-analysis

Background Optimum oral health is impossible to achieve without managing dental caries. The first step to manage dental caries at a community level is to know its prevalence and trend. Unfortunately, the prevalence of dental caries at the national/regional level is not known in many developing countries. Pakistan is no exception. The present meta-analysis was planned to document the prevalence of dental caries at the national, as well as regional level. This paper will serve as a baseline for making future health policies, and health promotion activities in the country. Methods Literature was searched through various databases, such as PubMed, SCOPUS, and Web of science using: "Prevalence", "Dental Caries", "Dental Decay" and "Severity" as keywords. Any study that reported the prevalence of dental caries, and was conducted in the Pakistani population was included. Thirty studies fulfilled the inclusion criteria. Quality assessment of all the included studies was performed using Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence studies. MedCalc software was used to analyze the data. Results In total 27,878 subjects were included in a meta-analysis from 30 studies. The prevalence estimate of dental caries at the national level was 56.62% (95% CI: 49.54 to 63.57). The I2 value was 99.07% (95% CI: 98.94 to 99.18), (I2 > 75%) indicating heterogeneity, hence pooled proportion was reported using a random-effect model. The prevalence estimate of dental caries in Sindh was 58.946% (95% CI: 43.796 to 73.274), and in Punjab, it was 55.445% (95% CI: 44.174 to 66.44), whilst in Baluchistan and KPK combined was 51.168% (95% CI: 22.930 to 79.004). Conclusion Based on the existing data nearly 60% of the Pakistani population have dental caries. The proportion is almost the same in all provinces. Most of the included studies were found to be of high risk.

A systematic review and meta-analysis of asymptomatic malaria infection in pregnant women in Sub-Saharan Africa: A challenge for malaria elimination efforts

Background In Sub-Saharan Africa (SSA), where malaria transmission is stable, malaria infection in pregnancy adversely affects pregnant women, fetuses, and newborns and is often asymptomatic. So far, a plethora of primary studies have been carried out on asymptomatic malaria infection in pregnant women in SSA. Nevertheless, no meta-analysis estimated the burden of asymptomatic malaria infection in pregnant women in SSA, so this meta-analysis was carried out to bridge this gap. Methods PubMed, Web of Science, Scopus, Embase, and ProQuest were systematically searched for relevant studies published until 4 August 2020, and also the expansion of the search was performed by October 24, 2020. We assessed heterogeneity among included studies using I-squared statistics (I2). Publication bias was assessed by visual inspection of the funnel plot and further quantitatively validated by Egger’s and Begg’s tests. The pooled prevalence and pooled odds ratio (OR) and their corresponding 95% Confidence Interval (CI) were estimated using the random-effects model in Stata 15 software. Results For this meta-analysis, we included 35 eligible studies. The overall prevalence estimate of asymptomatic Plasmodium infection prevalence was 26.1%% (95%CI: 21–31.2%, I2 = 99.0%). According to species-specific pooled prevalence estimate, Plasmodium falciparum was dominant species (22.1%, 95%CI: 17.1–27.2%, I2 = 98.6%), followed by Plasmodium vivax, Plasmodium malariae and Plasmodium ovale, respectively, found to be 3% (95%CI: 0–5%, I2 = 88.3%), 0.8% (95%CI: 0.3–0.13%, I2 = 60.5%), and 0.2% (95%CI: -0.01–0.5%, I2 = 31.5%). Asymptomatic malaria-infected pregnant women were 2.28 times more likely anemic (OR = 2.28, 95%CI: 1.66–3.13, I2 = 56.3%) than in non-infected pregnant women. Asymptomatic malaria infection was 1.54 times higher (OR = 1.54, 95%CI: 1.28–1.85, I2 = 11.5%) in primigravida women compared to multigravida women. Conclusion In SSA, asymptomatic malaria infection in pregnant women is prevalent, and it is associated with an increased likelihood of anemia compared to non-infected pregnant women. Thus, screening of asymptomatic pregnant women for malaria and anemia should be included as part of antenatal care.

Prevalence of schistosomiasis and its association with anemia among pregnant women: a systematic review and meta-analysis

Background Schistosomiasis is a highly prevalent parasitic disease that can lead to adverse maternal and perinatal outcomes. To our knowledge, there has been no systematic review and meta-analysis of schistosomiasis during pregnancy. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant published studies were searched in international databases (PubMed, Science Direct, Scopus, Web of Science, and Google Scholar), from their inception until May 31, 2020. The retrieved studies were assessed for quality using the Modified Newcastle-Ottawa Scale. OpenMeta Analyst software was used for the statistical analysis. Results Thirty-two studies enrolling 21024 pregnant women were included in this meta-analysis. All 32 of these studies were conducted in Africa. Of these studies, 19, 11, and 2 investigated S. mansoni, S. haematobium, and combined S. mansoni and S. haematobium infections, respectively. The pooled prevalence estimate of schistosomiasis during pregnancy was 13.2% (95 CI 11.0–15.4). A random model was used because of high heterogeneity (Q = 99.14; P < 0.001). In subgroup analyses, the pooled prevalence estimate of S. haematobium was significantly higher than the pooled prevalence estimates of S. mansoni [22.5% (95% CI 1.6–43.5) vs 8.7% (95% CI 6.0–11.3, P = 0.016), respectively]. The results of meta-regression analyses showed a non-significant difference in the prevalence of schistosomiasis during pregnancy according to the study sample sizes and year of publication. Only six studies evaluated the association between schistosomiasis during pregnancy and anemia. Schistosomiasis was associated with anemia in these six studies (OR = 3.02, 95% = 1.25‒7.28, P = 0.014). Conclusion The present meta-analysis suggests that schistosomiasis during pregnancy is an existing health problem. This meta-analysis also highlights the lack of data on the determinants and outcomes of schistosomiasis during pregnancy. Preventive measures are needed and could be part of antenatal care in areas endemic with schistosomiasis.

The Prevalence and Risk Factors of Hypertension among the Urban Population in Southeast Asian Countries: A Systematic Review and Meta-Analysis

The trend of global prevalence for hypertension has been dramatically increasing for the past two decades in Southeast Asian countries. A systematic review aiming to assess the prevalence of hypertension and its risk factors among the urban population in Southeast Asian countries was conducted. We performed database searches of PubMed and Web of Science and performed meta-analysis to determine the pooled prevalence estimate. The overall pooled prevalence estimate of hypertension for Southeast Asian urban population was 33.82%. Among this, 33.98% of hypertension was reported in the community and 32.45% among adolescents in school. The common risk factors that we found were male, ethnicity, education and socioeconomic level, body mass index, waist circumference, smoking, and dyslipidaemia. The review indicates an urgent need for primary and secondary prevention activities. Therefore, a multisectoral and intersectoral approach and collaboration should be undertaken to improve the overall health outcomes of all populations in all Southeast Asian countries.

Prevalence of Dental Caries in Pakistan. A systematic review and meta-analysis

BackgroundOptimum oral health is impossible to achieve without managing dental caries. The first step to manage dental caries at a community level is to know its prevalence and trend. Unfortunately, the prevalence of dental caries at the national/regional level is not known in many developing countries. Pakistan is no exception. The present meta-analysis was planned to document the prevalence of dental caries at the national, as well as regional level. This paper will serve as a baseline for making future health policies, and health promotion activities in the country.MethodsLiterature was searched through various databases, such as PubMed, SCOPUS, and Web of science using: "Prevalence", "Dental Caries", "Dental Decay" and "Severity" as keywords. Any study that reported the prevalence of dental caries, and was conducted in the Pakistani population was included. Thirty studies fulfilled the inclusion criteria. Quality assessment of all the included studies was performed using Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence studies. MedCalc software was used to analyze the data.ResultsIn total 26952 subjects were included in a meta-analysis from 30 studies. The prevalence estimate of dental caries at the national level was 56.62 % (95% CI: 49.54 to 63.57). The I2 value was 99.07% (95% CI: 98.94 to 99.18), (I2 > 75%) indicating heterogeneity, hence pooled proportion was reported using a random-effect model. The prevalence estimate of dental caries in Sindh was 58.946% (95% CI: 43.796 to 73.274), and in Punjab, it was 55.445% (95% CI: 44.174 to 66.44), whilst in Baluchistan and KPK combined was 51.168% (95% CI: 22.930 to 79.004). ConclusionBased on the existing data nearly 60 % of the Pakistani population have dental caries. The proportion is almost the same in all provinces. Most of the included studies were found to be of high risk.

Prevalence of malnutrition among children at primary cleft surgery: A cross-sectional analysis of a global database

SummaryBackgroundOrofacial clefts are common birth defects requiring prompt feeding support and timely surgery. Little information exists about the impact of inadequate care provision in poor-resource settings. We aimed to estimate the burden of malnutrition in children from 101 low- and middle-income countries (LMICs) using cleft surgery records collected by one cleft NGO.MethodsWe conducted a cross-sectional study using anonymised records of children ≤5 years who underwent cleft surgery between 2008 and 2018. The data included birth date, gender, weight at surgery, ethnicity, country of origin, and date of primary surgery and was analysed using descriptive statistics. The prevalence of malnutrition was derived from the generation of weight-for-age z scores and described in relation to cleft type, gender, and ethnicity/geography. For purpose of comparison, the most recent prevalence estimates for underweight in children under-5 were extracted from publicly available national surveys.FindingsThe analysis included 602,568 children. The overall prevalence of underweight at the time of primary cleft surgery was 28·6% – a figure well above the global underweight prevalence in under-5 children without cleft estimated at about 13·5%. The prevalence of underweight varied with the age at primary surgery and the type of cleft, as well as with gender, ethnicity, and region of origin, and was positively correlated with country-specific estimates of underweight prevalence in children without cleft.InterpretationOur findings support the need for advancing universal health coverage with special efforts to increase timely nutrition care and access to surgery for the most disadvantaged children.FundingNone.Research in contextEvidence before this studyRegardless of the setting, infants born with an orofacial cleft have a heightened risk of failure to thrive (FTT), especially when their ability to suck and swallow is compromised.(1-3) Timely identification of feeding problems and appropriate nutrition support are essential to ensure healthy child development.(4-6) Limited access to (specialist) care in LMICs increases the risk of FTT in babies with unrepaired cleft, yet limited research has described the extent of the problem in these settings.We searched Medline and Google Scholar up to April 2020 for studies that estimated the scale of malnutrition in children with cleft born in limited-resource settings. A 2019 systematic review of the literature identified seven cross-sectional or case-control studies conducted in LMICs (three in Africa(7-9), three in Latin America(10-12), one in Iran(13)).(14) We excluded one study in Brazil(10) which did not estimate undernutrition and found one additional cross-sectional study from South Africa.(15) Overall, seven hospital-based studies published between 1999 and 2017 included a total of 2,300 children <5 years old. They all provided evidence of malnutrition in this population, yet none was designed to give a global prevalence estimate.Added value of this studyThis study is the first that attempted to provide a global prevalence estimate of malnutrition in children with unrepaired cleft in LMICs. Using pre-surgery clinical records from over 600,000 of patients operated by Smile Train’s global partners, we identified underweight in 28·6% of children ≤5 years. Country-specific figures ranging from 6·9% in Kazakhstan to 48·2% in Chad were above national statistics on the prevalence of underweight in children in the general populations. Cleft epidemiology contributes to variations in malnutrition rates across LMIC settings but do not explain health disparities between children with cleft and those without cleft within countries.Implications of all the available evidenceThere is an urgent need to identify and/or address the barriers that prevent children with cleft from receiving immediate feeding and nutritional support and timely reparative surgery. Current health services and nutrition programmes in LMICs should consider opportunities to help meet the health care needs of these children. Poor early-life nutrition has well-documented detrimental consequences on child physical, functional, and cognitive development. Accordingly, a higher prevalence of malnutrition in children born with a cleft means that this population likely experiences higher rates of morbidity and mortality – even if they are eventually operated.

A Bayesian approach to estimating the population prevalence of mood and anxiety disorders using multiple measures

Aims There is currently no universally accepted measure for population-based surveillance of mood and anxiety disorders. As such, the use of multiple linked measures could provide a more accurate estimate of population prevalence. Our primary objective was to apply Bayesian methods to two commonly employed population measures of mood and anxiety disorders to make inferences regarding the population prevalence and measurement properties of a combined measure. Methods We used data from the 2012 Canadian Community Health Survey – Mental Health linked to health administrative databases in Ontario, Canada. Structured interview diagnoses were obtained from the survey, and health administrative diagnoses were identified using a standardised algorithm. These two prevalence estimates, in addition to data on the concordance between these measures and prior estimates of their psychometric properties, were used to inform our combined estimate. The marginal posterior densities of all parameters were estimated using Hamiltonian Monte Carlo (HMC), a Markov Chain Monte Carlo technique. Summaries of posterior distributions, including the means and 95% equally tailed posterior credible intervals, were used for interpretation of the results. Results The combined prevalence mean was 8.6%, with a credible interval of 6.8–10.6%. This combined estimate sits between Bayesian-derived prevalence estimates from administrative data-derived diagnoses (mean = 7.4%) and the survey-derived diagnoses (mean = 13.9%). The results of our sensitivity analysis suggest that varying the specificity of the survey-derived measure has an appreciable impact on the combined posterior prevalence estimate. Our combined posterior prevalence estimate remained stable when varying other prior information. We detected no problematic HMC behaviour, and our posterior predictive checks suggest that our model can reliably recreate our data. Conclusions Accurate population-based estimates of disease are the cornerstone of health service planning and resource allocation. As a greater number of linked population data sources become available, so too does the opportunity for researchers to fully capitalise on the data. The true population prevalence of mood and anxiety disorders may reside between estimates obtained from survey data and health administrative data. We have demonstrated how the use of Bayesian approaches may provide a more informed and accurate estimate of mood and anxiety disorders in the population. This work provides a blueprint for future population-based estimates of disease using linked health data.

Dental Caries in Pakistan. A Systematic Review and Meta-analysis

BackgroundOptimum oral health is impossible to achieve without managing dental caries. The first step to manage dental caries at community level is to know its prevalence, and trend. Unfortunately, prevalence of dental caries at national/regional level is not known in many developing countries. Pakistan is of no exception. The present meta-analysis was planned to document prevalence of dental caries at national, as well as regional level. This paper will serve as baseline for making future health policies, and health promotion activities in the country.MethodsLiterature was searched through various databases, such as PubMed, SCOPUS, and Web of science using: "Prevalence", "Dental Caries", "Dental Decay" and "Severity" as keywords. Any study that reported prevalence of dental caries, and was conducted in Pakistani population was included. Thirty studies fulfilled the mentioned criteria, and was included. Quality assessment of all the included studies was performed using Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence studies. MedCalc software was used to analyses the data.ResultsIn total 26952 subjects were included in meta-analysis from 30 studies. The prevalence estimate of dental caries at national level was 56.32 % (95% CI: 49.326 to 63.197). The I2 value was 99.07% (95% CI: 98.94 to 99.18), (I2 > 75%) indicating heterogeneity , hence pooled proportion was reported using random effect model. The prevalence estimate of dental caries in Sindh was 58.135% (95% CI: 43.906 to 71.705), and in Punjab it was 53.95% (95% CI: 44.179 to 63.57), whilst in Baluchistan and KPK combined was 51.17% (95% CI: 22.930 to 79.004).ConclusionBased on the existing data nearly 60 % of Pakistani population have dental caries. The proportion is almost same in all provinces. Most of the included studies found to be of high risk.