OBJECTIVE: An umbrella review providing a comprehensive synthesis of the interventions that are effective in providing routine immunisation outcomes for children in low and middle-income countries (L&MICs).
DESIGN: A systematic review of systematic reviews, or an umbrella review.
DATA SOURCES: We comprehensively searched 11 academic databases and 23 grey literature sources. The search was adopted from an evidence gap map on routine child immunisation sector in L&MICs, which was done on 5 May 2020. We updated the search in October 2021.
ELIGIBILITY CRITERIA: We included systematic reviews assessing the effectiveness of any intervention on routine childhood immunisation outcomes in L&MICs.
DATA EXTRACTION AND SYNTHESIS: Search results were screened by two reviewers independently applying predefined inclusion and exclusion criteria. Data were extracted by two researchers independently. The Specialist Unit for Review Evidence checklist was used to assess review quality. A mixed-methods synthesis was employed focusing on meta-analytical and narrative elements to accommodate both the quantitative and qualitative information available from the included reviews.
RESULTS: 62 systematic reviews are included in this umbrella review. We find caregiver-oriented interventions have large positive and statistically significant effects, especially those focusing on short-term sensitisation and education campaigns as well as written messages to caregivers. For health system-oriented interventions the evidence base is thin and derived from narrative synthesis suggesting positive effects for home visits, mixed effects for pay-for-performance schemes and inconclusive effects for contracting out services to non-governmental providers. For all other interventions under this category, the evidence is either limited or not available. For community-oriented interventions, a recent high-quality mixed-methods review suggests positive but small effects. Overall, the evidence base is highly heterogenous in terms of scope, intervention types and outcomes.
CONCLUSION: Interventions oriented towards caregivers and communities are effective in improving routine child immunisation outcomes. The evidence base on health system-oriented interventions is scant not allowing us to reach firm conclusions, except for home visits. Large evidence gaps exist and need to be addressed. For example, more high-quality evidence is needed for specific caregiver-oriented interventions (eg, monetary incentives) as well as health system-oriented (eg, health workers and data systems) and community-oriented interventions. We also need to better understand complementarity of different intervention types.
BACKGROUND: Pandemics can lead to mental health problems such as depression. This meta-analysis of meta-analyses aimed to estimate the precise prevalence of depression during the COVID-19 pandemic.
METHODS: Web of Science, PubMed, Scopus, and Embase were searched for published meta-analyses using relevant keywords, such as depression, prevalence, COVID-19, and meta-analysis up to March 18, 2024 according to the PRISMA guidelines. Relevant journals as well as the search engine Google Scholar were manually searched to discover more articles. The AMSTAR tool was used for quality assessment. A random-effects model was used for the analysis. All analyses were conducted using the STATA 17 software.
RESULTS: Of 535 records, 82 meta-analyses were included. The results showed that the overall prevalence of depression was 30% [95% CI: 29-32] with a high heterogeneity (I2: 90.98%). The highest prevalence of depression according to population group was found in medical students (40% [30-49]), specific groups (40% [3-78]), and patients (36% [27-45]). The results of meta-regression based on the different times between the start of COVID-19 and the last date of search in the articles (week) and the prevalence of depression, showed that each past week of Covid-19 increases the prevalence of depression by almost 0.00021% [95% CI: -0.00025, 0.00068], P-value: 0.36, but "time" is not a significant predictor of an increase in depression.
CONCLUSIONS: The results showed that the prevalence of depression was high during the COVID-19 pandemic, particularly among medical students. Policy makers should pay more attention to these groups and those who are at greater risk. Primary mental health interventions and policies are necessary to support the mental health of these individuals during the pandemic.
Mental health problems among children and adolescents are increasingly reported amidst the coronavirus disease (COVID-19) pandemic. In this umbrella review, we aimed to synthesize global evidence on the epidemiologic burden and correlates of child and adolescent mental health (CAMH) problems during this pandemic from existing systematic reviews and meta-analyses. Adopting the Joanna Briggs Institute (JBI) methodology, we evaluated 422 citations and identified 17 eligible reviews with medium to high methodological quality. Most of the reviews reported a high prevalence of anxiety, depression, sleep disorders, suicidal behavior, stress-related disorders, attention-deficit/hyperactivity disorder, and other mental health problems. Also, factors associated with CAMH such as age, gender, place of residence, educational attainment, household income, sedentary lifestyle, social media and internet use, comorbidities, family relationships, parents' psychosocial conditions, COVID-19 related experiences, closure of schools, online learning, and social support were reported across reviews. As most studies were cross-sectional and used nonrepresentative samples, future research on representative samples adopting longitudinal and intervention designs is needed. Lastly, multipronged psychosocial care services, policies, and programs are needed to alleviate the burden of CAMH problems during and after this pandemic.
An umbrella review providing a comprehensive synthesis of the interventions that are effective in providing routine immunisation outcomes for children in low and middle-income countries (L&MICs).
DESIGN:
A systematic review of systematic reviews, or an umbrella review.
DATA SOURCES:
We comprehensively searched 11 academic databases and 23 grey literature sources. The search was adopted from an evidence gap map on routine child immunisation sector in L&MICs, which was done on 5 May 2020. We updated the search in October 2021.
ELIGIBILITY CRITERIA:
We included systematic reviews assessing the effectiveness of any intervention on routine childhood immunisation outcomes in L&MICs.
DATA EXTRACTION AND SYNTHESIS:
Search results were screened by two reviewers independently applying predefined inclusion and exclusion criteria. Data were extracted by two researchers independently. The Specialist Unit for Review Evidence checklist was used to assess review quality. A mixed-methods synthesis was employed focusing on meta-analytical and narrative elements to accommodate both the quantitative and qualitative information available from the included reviews.
RESULTS:
62 systematic reviews are included in this umbrella review. We find caregiver-oriented interventions have large positive and statistically significant effects, especially those focusing on short-term sensitisation and education campaigns as well as written messages to caregivers. For health system-oriented interventions the evidence base is thin and derived from narrative synthesis suggesting positive effects for home visits, mixed effects for pay-for-performance schemes and inconclusive effects for contracting out services to non-governmental providers. For all other interventions under this category, the evidence is either limited or not available. For community-oriented interventions, a recent high-quality mixed-methods review suggests positive but small effects. Overall, the evidence base is highly heterogenous in terms of scope, intervention types and outcomes.
CONCLUSION:
Interventions oriented towards caregivers and communities are effective in improving routine child immunisation outcomes. The evidence base on health system-oriented interventions is scant not allowing us to reach firm conclusions, except for home visits. Large evidence gaps exist and need to be addressed. For example, more high-quality evidence is needed for specific caregiver-oriented interventions (eg, monetary incentives) as well as health system-oriented (eg, health workers and data systems) and community-oriented interventions. We also need to better understand complementarity of different intervention types.
