Modifiable risk factors for diphtheria: A systematic review and meta-analysis
Objective: To identify modifiable risk factors for diphtheria and assess their strengths of association with the disease. Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Electronic databases and grey lit...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | Global Epidemiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590113323000032 |
| _version_ | 1797798700290932736 |
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| author | Juniorcaius Ikejezie Busola Adebusoye Winifred Ekezie Tessa Langley Sarah Lewis Revati Phalkey |
| author_facet | Juniorcaius Ikejezie Busola Adebusoye Winifred Ekezie Tessa Langley Sarah Lewis Revati Phalkey |
| author_sort | Juniorcaius Ikejezie |
| collection | DOAJ |
| description | Objective: To identify modifiable risk factors for diphtheria and assess their strengths of association with the disease. Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Electronic databases and grey literature were searched from inception until January 2023. Studies had to report on diphtheria cases and estimates of association for at least one potential risk factor or sufficient data to calculate these. The quality of non-ecological studies was assessed using the Newcastle-Ottawa Scale (NOS), while the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: The search yielded 37,705 papers, of which 29 were ultimately included. All the non-ecological studies were of moderate to high quality. Meta-analysis of 20 studies identified three factors increasing the risk of diphtheria: incomplete vaccination (<3 doses) (pooled odds ratio (POR) = 2.2, 95% confidence interval (CI) = 1.4–3.4); contact with a person with skin lesions (POR = 4.8, 95% CI = 2.1–10.9); and low knowledge of diphtheria (POR = 2.4, 95% CI = 1.2–4.7). Contact with a case of diphtheria; sharing a bed or bedroom; sharing utensils, cups, and glasses; infrequent bathing; and low parental education were associated with diphtheria in multiple studies. Evidence for other factors was inconclusive. The quality of evidence was low or very low for all the risk factors. Conclusions: Findings from the review suggest that countries seeking to control diphtheria need to strengthen surveillance, improve vaccination coverage, and increase people's knowledge of the disease. Future research should focus on understudied or inconclusive risk factors. |
| first_indexed | 2024-03-13T04:07:47Z |
| format | Article |
| id | doaj.art-daf6e5a26b0a45ba8f2853afe27c506b |
| institution | Directory Open Access Journal |
| issn | 2590-1133 |
| language | English |
| last_indexed | 2024-03-13T04:07:47Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Global Epidemiology |
| spelling | doaj.art-daf6e5a26b0a45ba8f2853afe27c506b2023-06-21T06:59:00ZengElsevierGlobal Epidemiology2590-11332023-12-015100100Modifiable risk factors for diphtheria: A systematic review and meta-analysisJuniorcaius Ikejezie0Busola Adebusoye1Winifred Ekezie2Tessa Langley3Sarah Lewis4Revati Phalkey5Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK; Corresponding author at: Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Room B126, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, United Kingdom.Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UKDivision of Epidemiology and Public Health, School of Medicine, University of Nottingham, UKDivision of Epidemiology and Public Health, School of Medicine, University of Nottingham, UKDivision of Epidemiology and Public Health, School of Medicine, University of Nottingham, UKDivision of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK; Climate Change and Health Unit, UK Health Security Agency, London, United Kingdom; Heidelberg Institute of Global Health, University of Heidelberg, GermanyObjective: To identify modifiable risk factors for diphtheria and assess their strengths of association with the disease. Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Electronic databases and grey literature were searched from inception until January 2023. Studies had to report on diphtheria cases and estimates of association for at least one potential risk factor or sufficient data to calculate these. The quality of non-ecological studies was assessed using the Newcastle-Ottawa Scale (NOS), while the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: The search yielded 37,705 papers, of which 29 were ultimately included. All the non-ecological studies were of moderate to high quality. Meta-analysis of 20 studies identified three factors increasing the risk of diphtheria: incomplete vaccination (<3 doses) (pooled odds ratio (POR) = 2.2, 95% confidence interval (CI) = 1.4–3.4); contact with a person with skin lesions (POR = 4.8, 95% CI = 2.1–10.9); and low knowledge of diphtheria (POR = 2.4, 95% CI = 1.2–4.7). Contact with a case of diphtheria; sharing a bed or bedroom; sharing utensils, cups, and glasses; infrequent bathing; and low parental education were associated with diphtheria in multiple studies. Evidence for other factors was inconclusive. The quality of evidence was low or very low for all the risk factors. Conclusions: Findings from the review suggest that countries seeking to control diphtheria need to strengthen surveillance, improve vaccination coverage, and increase people's knowledge of the disease. Future research should focus on understudied or inconclusive risk factors.http://www.sciencedirect.com/science/article/pii/S2590113323000032DiphtheriaRisk factorsInfectious diseaseSystematic reviewmeta-analysis |
| spellingShingle | Juniorcaius Ikejezie Busola Adebusoye Winifred Ekezie Tessa Langley Sarah Lewis Revati Phalkey Modifiable risk factors for diphtheria: A systematic review and meta-analysis Global Epidemiology Diphtheria Risk factors Infectious disease Systematic review meta-analysis |
| title | Modifiable risk factors for diphtheria: A systematic review and meta-analysis |
| title_full | Modifiable risk factors for diphtheria: A systematic review and meta-analysis |
| title_fullStr | Modifiable risk factors for diphtheria: A systematic review and meta-analysis |
| title_full_unstemmed | Modifiable risk factors for diphtheria: A systematic review and meta-analysis |
| title_short | Modifiable risk factors for diphtheria: A systematic review and meta-analysis |
| title_sort | modifiable risk factors for diphtheria a systematic review and meta analysis |
| topic | Diphtheria Risk factors Infectious disease Systematic review meta-analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2590113323000032 |
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