School closures during pandemics raise important concerns for children and adolescents. Our aim is synthesizing available data on the impact of school closure during the coronavirus disease 2019 (COVID-19) pandemic on child and adolescent health globally. We conducted a rapid systematic review by searching PubMed, Embase, and Google Scholar for any study published between January and September 2020. We included a total of ten primary studies. COVID-19-related school closure was associated with a significant decline in the number of hospital admissions and pediatric emergency department visits. However, a number of children and adolescents lost access to school-based healthcare services, special services for children with disabilities, and nutrition programs. A greater risk of widening educational disparities due to lack of support and resources for remote learning were also reported among poorer families and children with disabilities. School closure also contributed to increased anxiety and loneliness in young people and child stress, sadness, frustration, indiscipline, and hyperactivity. The longer the duration of school closure and reduction of daily physical activity, the higher was the predicted increase of Body Mass Index and childhood obesity prevalence. There is a need to identify children and adolescents at higher risk of learning and mental health impairments and support them during school closures.

AIMSThe aim of this study was to perform an up-to-date meta-analysis on the risk of cardiac malformations associated with gestational exposure to paroxetine, taking into account indication, study design and reference category. METHODA systematic review of studies published between 1966 and November 2015 was conducted using EMBASE and MEDLINE. Studies reporting major malformations with first trimester exposure to paroxetine were included. Potentially relevant articles were assessed and relevant data extracted to calculate risk estimates. Outcomes included any major malformations and major cardiac malformations. Pooled odds ratios and 95% confidence intervals were calculated using random-effects models. RESULTSTwenty-three studies were included. Compared with non-exposure to paroxetine, first trimester use of paroxetine was associated with an increased risk of any major congenital malformations combined (pooled OR 1.23, 95% CI 1.10, 1.38; n = 15 studies), major cardiac malformations (pooled OR 1.28, 95% CI 1.11, 1.47; n = 18 studies), specifically bulbus cordis anomalies and anomalies of cardiac septal closure (pooled OR 1.42, 95% CI 1.07, 1.89; n = 8 studies), atrial septal defects (pooled OR 2.38, 95% CI 1.14, 4.97; n = 4 studies) and right ventricular outflow track defect (pooled OR 2.29, 95% CI 1.06, 4.93; n = 4 studies). Although the estimates varied depending on the comparator group, study design and malformation detection period, a trend towards increased risk was observed. CONCLUSIONSParoxetine use during the first trimester of pregnancy is associated with an increased risk of any major congenital malformations and cardiac malformations. The increase in risk is not dependent on the study method or population.

to support the global strategy to reduce risk factors for obesity, we synthesized the evidence on physical activity (pA) and sedentary behaviour in the Middle east and north Africa (MenA) region. Our systematic overview included seven systematic reviews reporting 229 primary studies. The metaanalysis included 125 prevalence measures from 20 MENA countries. After 2000, 50.8% of adults (ranging from 13.2% in Sudan to 94.9% in Jordan) and 25.6% of youth (ranging from 8.3% in Egypt to 51.0% in Lebanon) were sufficiently active. Limited data on PA behaviours is available for MENA countries, with the exception of Gulf Cooperation Council countries. The meta-regression identified gender and geographical coverage among youth, and the pA measurement as predictors of pA prevalence for both adults and youth. Our analysis suggests a significant PA prevalence increase among adults over the last two decades. the inconsistency in sedentary behaviour measurement is related to the absence of standardized guidelines for its quantification and interpretation. The global epidemic of insufficient PA is prevalent in MENA. Lower PA participation among youth and specifically females should be addressed by focused lifestyle interventions. the recognition of sedentary behaviour as a public health issue in the region remains unclear. Additional data on pA behaviours is needed from lowand middle-income countries in the region. Non-communicable diseases (NCDs) kill 41 million people worldwide each year-equivalent to 71% of all deaths 1. The Middle East and North Africa (MENA) region has one of the highest rates of NCDs in the world. In 2017, the region reported the second highest prevalence of diabetes in the world (10.8%) 2 and is recording a rapid increase in obesity 3,4. Insufficient physical activity (PA) and sedentary behaviour are key risk factors for obesity and other NCDs 5-15 leading to premature mortality 10,11,16-18. It has been suggested that PA has the potential to effectively control and reduce the burden of obesity during the various phases of human development 19. Regular PA can also improve self-esteem, cognitive performance, and academic achievement in young people 7,20,21 and is positively related to cardiorespiratory and metabolic health 6. Recently, sedentary behaviour has received global attention as prolonged sedentary time is associated with an increased risk of chronic disease and an increase in all-cause mortality, regardless of individuals meeting the recommended levels of PA 13,15. The World Health Organization (WHO) and the Global Observatory for Physical Activity (GoPA) are targeting a relative reduction of 10% in the global prevalence of physical inactivity among adults by 2025 22,23. Currently, one of the most pressing needs to improve population health is to develop appropriate policies and implement interventions to address the global pandemic of physical inactivity 24,25. However, to support this action, country-level evidence on PA behaviour in various population groups is essential. Both regional-and coun...

This study aimed at characterizing herpes simplex virus type 1 (HSV-1) epidemiology in the Middle East and North Africa (MENA). HSV-1 records were systematically reviewed. Findings were reported following the PRISMA guidelines. Random-effects meta-analyses were implemented to estimate pooled mean HSV-1 seroprevalence. Random-effects meta-regressions were conducted to identify predictors of higher seroprevalence. Thirty-nine overall seroprevalence measures yielding 85 stratified measures were identified and included in the analyses. Pooled mean seroprevalence was 65.2% (95% CI: 53.6–76.1%) in children, and 91.5% (95% CI: 89.4–93.5%) in adults. By age group, seroprevalence was lowest at 60.5% (95% CI: 48.1–72.3%) in <10 years old, followed by 85.6% (95% CI: 80.5–90.1%) in 10–19 years old, 90.7% (95% CI: 84.7–95.5%) in 20–29 years old, and 94.3% (95% CI: 89.5–97.9%) in ≥30 years old. Age was the strongest predictor of seroprevalence explaining 44.3% of the variation. Assay type, sex, population type, year of data collection, year of publication, sample size, and sampling method were not significantly associated with seroprevalence. The a priori considered factors explained 48.6% of the variation in seroprevalence. HSV-1 seroprevalence persists at high levels in MENA with most infections acquired in childhood. There is no evidence for declines in seroprevalence despite improving socio-economic conditions.

Background In nursing students, high stress levels can lead to burnout, anxiety, and depression. Our objective is to characterize the epidemiology of perceived stress, stressors, and coping strategies among nursing students in the Middle East and North Africa region. Methods We conducted an overview of systematic reviews. We systematically searched PubMed, Embase, PsycInfo, and grey literature sources between January 2008 and June 2020 with no language restrictions. We included any systematic review reporting measurable stress-related outcomes including stress prevalence, stressors, and stress coping strategies in nursing students residing in any of the 20 Middle East and North Africa countries. We also included additional primary studies identified through a hand search of the reference lists of relevant primary studies and systematic reviews. Results Seven systematic reviews and 42 primary studies with data from Bahrain, Egypt, Iraq, Jordan, Oman, Pakistan, Palestine, Saudi Arabia, and Sudan were identified. Most studies included nursing students undergoing clinical training. The prevalence range of low, moderate, and high perceived stress among nursing students was 0.8–65%, 5.9–84.5%, and 6.7–99.2%, respectively. Differences related to gender, training period, or the type of tool used to measure stress remain unclear given the wide variability in the reported prevalence measures across all stress levels. Common clinical training stressors were assignments, workload, and patient care. Academic training-related stressors included lack of break/leisure time, low grades, exams, and course load. Nursing students utilized problem focused (dealing with the problem), emotion focused (regulating the emotion), and dysfunctional (venting the emotions) stress coping mechanisms to alleviate their stress. Conclusions Available data does not allow the exploration of links between stress levels, stressors, and coping strategies. Limited country-specific prevalence data prevents comparability between countries. Reducing the number or intensity of stressors through curriculum revision and improving students’ coping response could contribute to the reduction of stress levels among students. Mentorship, counseling, and an environment conducive to clinical training are essential to minimize perceived stress, enhance learning, and productivity, and prevent burnout among nursing students.

Increasing physical inactivity levels in the Middle East and North Africa (MENA) region is a public health concern. We aimed to synthesize barriers and facilitators to physical activity and make appropriate recommendations to address physical inactivity. We conducted an overview of systematic reviews on physical activity barriers and facilitators in 20 MENA countries by systematically searching MEDLINE/PubMed and Google Scholar for systematic reviews published between 2008 and 2020. Our overview included four systematic reviews and 119 primary studies with data from 17 MENA countries. Lack of suitable sports facilities, time, social support and motivation, gender and cultural norms, harsh weather, and hot climate were the most commonly reported barriers to physical activity. Socio-demographic factors negatively associated with physical activity participation include advanced age, being female, less educated, and being married. Motivation to gain health benefits, losing/maintaining weight, being male, dietary habits, recreation, and increased Body Mass Index are positively associated with increased levels of physical activity. Interventions promoting physical activity in MENA should target schoolchildren, women and girls, working parents, and the elderly. Country-specific sociocultural and environmental factors influencing physical activity should be considered in the design of interventions. Current and future policies and national interventions must be consistently evaluated for effectiveness and desired outcomes.

BackgroundIt is known that antimalarial drugs reduce the risk of low birth weight (LBW) in pregnant patients. However, a previous Cochrane review did not evaluate whether the level of antimalarial drug resistance could modify the protective effect of antimalarial drugs in this regard. In addition, no systematic review exists comparing current recommendations for malaria prevention during pregnancy to alternative regimens in Africa. Therefore, we conducted a comprehensive systematic review and meta-analysis to assess the efficacy of antimalarial drugs for malaria prevention during pregnancy in reducing the risk of LBW.MethodsWe searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for articles published up to 21 November 2014, in English or French, and identified additional studies from reference lists. We included randomized and quasi-randomized studies reporting LBW as one of the outcomes. We extracted data and assessed the risk of bias in selected studies. All pooled analyses were based on a random effect model, and we used a funnel plot and trim and fill method to test and adjust for publication bias.ResultsA total of 25 studies met the inclusion criteria (37,981 subjects). Compared to no use, all combined antimalarial drugs were associated with a 27 % (RR 0.73, 95 % CI 0.56–0.97, ten studies) reduction in the risk of LBW. The level of antimalarial drug resistance modified the protective effect of the antimalarial drug used for prevention of LBW during pregnancy. Sulfadoxine-pyrimethamine was not associated with a reduction in the risk of LBW in regions where the prevalence of the dihydropteroate synthase 540E mutation exceeds 50 % (RR 0.99, 95 % CI 0.80–1.22, three studies). The risk of LBW was similar when sulfadoxine-pyrimethamine was compared to mefloquine (RR 1.05, 95 % CI 0.86–1.29, two studies).ConclusionProphylactic antimalarial drugs and specifically sulfadoxine-pyrimethamine may no longer protect against the risk of LBW in areas of high-level resistance. In Africa, there are currently no suitable alternative drugs to replace sulfadoxine-pyrimethamine for malaria prevention during pregnancy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0429-x) contains supplementary material, which is available to authorized users.

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