Assignment Task:
Title
The proportion of iron deficiency anemia associated with active H.pylori infection in low and middle income countries: An updated systematic review and meta-analysis
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Search strategy and Data sources
We undertook and report this systematic review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. [21].Our review was registered with PROSPERO. On 18 May 2020, we searched the Ovid MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science databases. All suitable studies published from 2010 t0 2020 will be included.
The search strategy was formulated in PubMed and adapted for other databases. The following PubMed search includes the terms and concepts used: (“Anemia”[mesh] OR “Iron, Dietary”[mesh] OR “Iron”[mesh] OR anemia [tiab] OR anemic [tiab] OR anaemia[tiab] OR anaemic [tiab] OR iron* [tiab] OR IDA [tiab]) AND (” H.plori”[mesh] OR “Hepicidin”[mesh] OR “IDA and Hepcidin”[mesh] search terms were “Helicobacter pylori, Campylobacter pylori, H. pylori or C. pylori”; and “iron deficiency, iron deficiency anemia, anemia, serum hepcidin, serum ferritin, hemoglobin or iron stores.” A sample of search strategy is provided in Appendix 1. We also searched reference lists of original and review articles.
Study selection and data extraction
Inclusion Criteria
Selection, grading, and clarification of studies
- Eligible studies were observational studies (cross-sectional, case– control, and cohort studies) and interventional studies/clinical trials.
- HP diagnosis must be confirmed by one of the following tests: HP serology, HP stool antigen, urea breath test, biopsies for
- Campylobacter-like organism test, rapid urease test, histology, or culture
- The study participants must be reflective of the general population in the region
- Data from multicenter and multinational studies were extracted separately and sorted by countries and regions
- Studies were classified as national (if stated in the report or multicenter study involving multiple regions in the country), sub-national (if only a particular region was evaluated), and city level
- Clarifications with the corresponding authors of studies with missing data were made if possible (eg, without specified HP diagnostic method or study period) .Attempts were made to rectify any data errors found in the studies, in consultation with the corresponding authors whenever possible
- Articles were selected for full review if they were related to IDA in children who received an intervention (supplementation or screening and related treatment) between the ages of 6 and 24 months. We restricted inclusion to English-language articles and excluded studies published only as abstracts.
- Prevalence of “anemia” in pregnant women using World Health Organization (WHO) criterion for anemia (Hb < 11 g/dl) in English languages.
- Studies will be included if they reported prevalence of anemia for aged predominantly 65 and over living in developing countries, together with the criteria used to define anemia.
- Studies that report hematological indices for the diagnosis of iron deficiency anemia such as hemoglobin level, complete blood count and biochemical parameters
[ferritin, iron, total iron binding capacity (TIBC), transferrin
saturation (TfS), C-reactive protein (CRP) bilirubin and hepcidin]
Exclusion criteria
Publication type
- Guidelines
- Perspectives, correspondence, letters
- Conference abstract or presentation without formal publication
- Systematic reviews or meta-analyses
- Surveillance registration or national notifiable disease reports of HP
- Studies without defined study periods
Study type
- Economic analyses
- Modeling, time series, or transmission studies; mortality or survival analyses; diagnostic assay or test performance studies; animal
- studies
Study Population
- Study populations that are typically associated with higher prevalence of HP (eg, patients with gastric cancer, peptic ulcers)
- High-risk population groups (migrants, refugees, prisoners, individuals [groups] classified as low socioeconomic status, homeless
- people, adoptees)
Study participants
- that were restricted to selected age groups (eg, children, elderly)
Testing
- HP diagnosis made from methods other than the 4 conventional tests stated above
Studies not reporting the method of HP diagnosis
Self-reported HP infection
Studies not reporting the number of individuals on which the prevalence estimate was based Studies conducted in low and middle-income countries (LMICs were also included. A country’s designation as low- or middle-income was guided by the World Bank’s 2016 Classification of the World Economy criteria. The search was limited to manuscripts published in English from January 2010 until April 30, 2020.
Outcome Measures
Primary outcomesof interest was H.pylori status. Secondary outcomes of interest was to examined whether persons with H. pylori infection have possible association with iron deficiency anemia compared to persons with no evidence of H. pylori infection.
Study selection
Two reviewers independently screened titles and abstracts of identified studies to include studies based on general relevance to the topic of interest. Second, both reviewers screened the titles and abstracts of studies included in step one to include studies based on reporting of the primary outcomes of interest (H.pylori status). In this second step, full texts were also screened. Finally, both reviewers reviewed the full-texts of studies included in step two to assess eligibility based on all population, intervention, comparison and setting (PICOS) criteria. When there was disagreement regarding eligibility, a third team member (AS) was asked to arbitrate.
Data Extraction
Two reviewer’s independently extracted data from each eligible study using a Cochrane Collaboration standard data extraction form [22]. Differences were resolved by discussion between reviewers. The following information was abstracted directly from the articles: study design, study population, sampling frame, sample size, H. pylori infection detection method, various biochemical marker of iron status, classification of IDA, ID, and anemia, results and adjustment for confounders. We extracted data on the number of individuals infected with H. pylori, the number of uninfected ones, and the number of those with IDA/ID in each study group.
Assessment of the methodological quality of the studies
A modified scale proposed by Slim et al. was used to assess the methodological quality of the observational studies. The scale included eight items (Appendix 2): A score of 2 was assigned if the item was met and reported adequately in the article, 1 if the item was reported but inadequate and 0 if the item was not reported. The sum of the points comprised the quality assessment score.
The methodological quality of the RCT was evaluated using the Cochrane Collaboration’s tool for assessing risk of bias.
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