Epidemics, Lockdown Measures and Vulnerable Populations: A Mixed-Methods Systematic Review of the Evidence of Impacts on Mother and Child Health in Low- and Lower-Middle-Income Countries

Document Type : Review Article

Authors

1 Wolfson Institute of Population Health, Queen Mary University of London, London, UK

2 Global Health & Tropical Medicine, Instituto de Higiene e Medicina Tropical, Nova University of Lisbon, Lisbon, Portugal

3 Faculty of Arts & Social Sciences, School of Social Sciences & Global Studies, Open University, Milton Keynes, UK

4 Royal Veterinary College, University of London, London, UK

Abstract

Background 
The aim of this research was to synthetise the existing evidence on the impact of epidemic-related lockdown measures on women and children’s health in low- and lower-middle-income countries (LLMICs).

Methods 
A mixed-methods systematic review was conducted of qualitative, quantitative and mixed-methods evidence. Between 1st and 10th of November 2021, seven scientific databases were searched. The inclusion criteria were that the paper provided evidence on the impact of lockdown and related measures, focused on LLMICs, addressed impacts on women and child’s health, addressed epidemics from 2000-2020, was peer-reviewed, provided original evidence, and was published in English. The Joanne Briggs Institute’s critical appraisal tools were used to assess the quality of the studies, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. The evidence from the papers was grouped by type of lockdown measure and categories of impact, using a narrative databased convergent synthesis design.

Results 
The review process identified 46 papers meeting the inclusion criteria from 17 countries that focussed on the coronavirus disease 2019 (COVID-19) and Ebola epidemics. The evidence on the decrease of utilisation of health services showed plummeting immunisation rates and faltering use of maternal and perinatal services, which was linked to a growth of premature deaths. Impacts on the mental health of children and women were convincingly established, with lockdowns associated with surges in depression, anxiety and low life satisfaction. Vulnerability may be compounded by lockdowns, as livelihoods were disrupted, and poverty levels increased.

Conclusion 
Limitations included that searches were conducted in late-2020 as new research was being published, and that some evidence not published in English may have been excluded. Epidemic-related lockdown measures carry consequences for the health of women and children in lower-income settings. Governments will need to weigh the tradeoffs of introducing such measures and consider policies to mitigate their impacts on the most vulnerable.

Keywords

Main Subjects


  1. Bassareo PP, Melis MR, Marras S, Calcaterra G. Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine. Postgrad Med J. 2020;96(1140):633-638. doi:1136/postgradmedj-2020-138370
  2. Flaxman S, Mishra S, Gandy A, et al. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature. 2020;584(7820):257-261. doi:1038/s41586-020-2405-7
  3. Espinoza B, Castillo-Chavez C, Perrings C. Mobility restrictions for the control of epidemics: when do they work? PLoS One. 2020;15(7):e0235731. doi:1371/journal.pone.0235731
  4. Poole S. From Barges to Barricades: The Changing Meaning of “Lockdown”. The Guardian. http://www.theguardian.com/books/2020/apr/02/changing-meaning-of-lockdown. Accessed April 26, 2021. Published April 2, 2020.
  5. Vinceti M, Filippini T, Rothman KJ, et al. Lockdown timing and efficacy in controlling COVID-19 using mobile phone tracking. EClinicalMedicine. 2020;25:100457. doi:1016/j.eclinm.2020.100457
  6. World Economic Outlook - The Great Lockdown. International Monetary Fund. https://www.imf.org/en/Publications/WEO/Issues/2020/04/14/weo-april-2020. Accessed April 24, 2020. Published 2020.
  7. Ravindran S, Shah M. Unintended Consequences of Lockdowns: COVID-19 and the Shadow Pandemic. National Bureau of Economic Research; 2020. doi:3386/w27562
  8. Chiwona-Karltun L, Amuakwa-Mensah F, Wamala-Larsson C, et al. COVID-19: from health crises to food security anxiety and policy implications. Ambio. 2021;50(4):794-811. doi:1007/s13280-020-01481-y
  9. Pierce M, Hope H, Ford T, et al. Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. Lancet Psychiatry. 2020;7(10):883-892. doi:1016/s2215-0366(20)30308-4
  10. Robinson E, Boyland E, Chisholm A, et al. Obesity, eating behavior and physical activity during COVID-19 lockdown: a study of UK adults. Appetite. 2021;156:104853. doi:1016/j.appet.2020.104853
  11. 11 Davies NG, Barnard RC, Jarvis CI, et al. Association of tiered restrictions and a second lockdown with COVID-19 deaths and hospital admissions in England: a modelling study. Lancet Infect Dis. 2021;21(4):482-492. doi:1016/s1473-3099(20)30984-1
  12. Abrams EM, Szefler SJ. COVID-19 and the impact of social determinants of health. Lancet Respir Med. 2020;8(7):659-661. doi:1016/s2213-2600(20)30234-4
  13. Glover RE, van Schalkwyk MCI, Akl EA, et al. A framework for identifying and mitigating the equity harms of COVID-19 policy interventions. J Clin Epidemiol. 2020;128:35-48. doi:1016/j.jclinepi.2020.06.004
  14. Love DC, Allison EH, Asche F, et al. Emerging COVID-19 impacts, responses, and lessons for building resilience in the seafood system. Glob Food Sec. 2021;28:100494. doi:1016/j.gfs.2021.100494
  15. Lenhardt A. Pushing People Further into Poverty: The Impact of COVID-19 in Lower- and Middle- Income Countries. ODI Expert Comment. https://www.odi.org/blogs/17752-pushing-people-further-poverty-impact-covid-19-lower-and-middle-income-countries. Accessed February 16, 2021. Published 2020.
  16. Fore HH. A wake-up call: COVID-19 and its impact on children's health and wellbeing. Lancet Glob Health. 2020;8(7):e861-e862. doi:1016/s2214-109x(20)30238-2
  17. Cabore JW, Karamagi HC, Kipruto H, et al. The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African Region: a predictive model. BMJ Glob Health. 2020;5(5):e002647. doi:1136/bmjgh-2020-002647
  18. El-Sadr WM, Justman J. Africa in the path of COVID-19. N Engl J Med. 2020;383(3):e11. doi:1056/NEJMp2008193
  19. Nussbaumer-Streit B, Mayr V, Dobrescu AI, et al. Quarantine alone or in combination with other public health measures to control COVID-19: a rapid review. Cochrane Database Syst Rev. 2020;9(9):CD013574. doi:1002/14651858.CD013574.pub2
  20. Stern C, Lizarondo L, Carrier J, et al. Methodological guidance for the conduct of mixed methods systematic reviews. JBI Evid Synth. 2020;18(10):2108-2118. doi:11124/jbisrir-d-19-00169
  21. Anderson LM, Oliver SR, Michie S, Rehfuess E, Noyes J, Shemilt I. Investigating complexity in systematic reviews of interventions by using a spectrum of methods. J Clin Epidemiol. 2013;66(11):1223-1229. doi:1016/j.jclinepi.2013.06.014
  22. Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy. 2005;10(1):45-53. doi:1177/135581960501000110
  23. Hong QN, Pluye P, Bujold M, Wassef M. Convergent and sequential synthesis designs: implications for conducting and reporting systematic reviews of qualitative and quantitative evidence. Syst Rev. 2017;6(1):61. doi:1186/s13643-017-0454-2
  24. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. doi:1136/bmj.b2535
  25. Ahmed S, Ajisola M, Azeem K, et al. Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements. BMJ Glob Health. 2020;5(8):e003042. doi:1136/bmjgh-2020-003042
  26. Morris D, Rogers M, Kissmer N, Du Preez A, Dufourq N. Impact of lockdown measures implemented during the Covid-19 pandemic on the burden of trauma presentations to a regional emergency department in Kwa-Zulu Natal, South Africa. Afr J Emerg Med. 2020;10(4):193-196. doi:1016/j.afjem.2020.06.005
  27. Haider N, Osman AY, Gadzekpo A, et al. Lockdown measures in response to COVID-19 in nine sub-Saharan African countries. BMJ Glob Health. 2020;5(10):e003319. doi:1136/bmjgh-2020-003319
  28. The World Bank. World Bank Country and Lending Groups. 2021. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed January 19, 2021.
  29. Joanna Briggs Institute. Critical Appraisal Tools. https://joannabriggs.org/critical-appraisal-tools. Accessed February 3, 2021. Published 2021.
  30. Weiss DJ, Bertozzi-Villa A, Rumisha SF, et al. Indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa: a geospatial modelling analysis. Lancet Infect Dis. 2021;21(1):59-69. doi:1016/s1473-3099(20)30700-3
  31. Hogan A, Jewell B, Sherrard-Smith E, et al. Report 19: The Potential Impact of the COVID-19 Epidemic on HIV, TB and Malaria in Low- and Middle-Income Countries. Imperial College London; 2020. doi:25561/78670
  32. Jewell BL, Mudimu E, Stover J, et al. Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models. Lancet HIV. 2020;7(9):e629-e640. doi:1016/s2352-3018(20)30211-3
  33. Bell D, Hansen KS, Kiragga AN, Kambugu A, Kissa J, Mbonye AK. Predicting the impact of COVID-19 and the potential impact of the public health response on disease burden in Uganda. Am J Trop Med Hyg. 2020;103(3):1191-1197. doi:4269/ajtmh.20-0546
  34. Ly J, Sathananthan V, Griffiths T, et al. Facility-based delivery during the Ebola virus disease epidemic in rural Liberia: analysis from a cross-sectional, population-based household survey. PLoS Med. 2016;13(8):e1002096. doi:1371/journal.pmed.1002096
  35. McQuilkin PA, Udhayashankar K, Niescierenko M, Maranda L. Health-care access during the Ebola virus epidemic in Liberia. Am J Trop Med Hyg. 2017;97(3):931-936. doi:4269/ajtmh.16-0702
  36. Quaglio G, Tognon F, Finos L, et al. Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: a prospective observational study. BMJ Open. 2019;9(9):e029093. doi:1136/bmjopen-2019-029093
  37. Ali M, Ahsan GU, Khan R, Khan HR, Hossain A. Immediate impact of stay-at-home orders to control COVID-19 transmission on mental well-being in Bangladeshi adults: patterns, explanations, and future directions. BMC Res Notes. 2020;13(1):494. doi:1186/s13104-020-05345-2
  38. Pandey D, Bansal S, Goyal S, et al. Psychological impact of mass quarantine on population during pandemics-the COVID-19 Lock-Down (COLD) study. PLoS One. 2020;15(10):e0240501. doi:1371/journal.pone.0240501
  39. Gutiérrez-Romero R, Ahamed M. COVID-19 response needs to broaden financial inclusion to curb the rise in poverty. World Dev. 2021;138:105229. doi:1016/j.worlddev.2020.105229
  40. Mohapatra S. Gender differentiated economic responses to crises in developing countries: insights for COVID-19 recovery policies. Rev Econ Househ. 2020:1-16. doi:1007/s11150-020-09512-z
  41. Kodish SR, Bio F, Oemcke R, et al. A qualitative study to understand how Ebola virus disease affected nutrition in Sierra Leone-a food value-chain framework for improving future response strategies. PLoS Negl Trop Dis. 2019;13(9):e0007645. doi:1371/journal.pntd.0007645
  42. Sediri S, Zgueb Y, Ouanes S, et al. Women's mental health: acute impact of COVID-19 pandemic on domestic violence. Arch Womens Ment Health. 2020;23(6):749-756. doi:1007/s00737-020-01082-4
  43. Dutta K, Mukherjee R, Sen D, Sahu S. Effect of COVID-19 lockdown on sleep behavior and screen exposure time: an observational study among Indian school children. Biol Rhythm Res. 2020:1-12. doi:1080/09291016.2020.1825284
  44. Kodish SR, Simen-Kapeu A, Beauliere JM, et al. Consensus building around nutrition lessons from the 2014-16 Ebola virus disease outbreak in Guinea and Sierra Leone. Health Policy Plan. 2019;34(2):83-91. doi:1093/heapol/czy108
  45. Roberton T, Carter ED, Chou VB, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health. 2020;8(7):e901-e908. doi:1016/s2214-109x(20)30229-1
  46. Plucinski MM, Guilavogui T, Sidikiba S, et al. Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014: a cross-sectional survey of health facilities. Lancet Infect Dis. 2015;15(9):1017-1023. doi:1016/s1473-3099(15)00061-4
  47. Parpia AS, Ndeffo-Mbah ML, Wenzel NS, Galvani AP. Effects of response to 2014-2015 Ebola outbreak on deaths from malaria, HIV/AIDS, and tuberculosis, West Africa. Emerg Infect Dis. 2016;22(3):433-441. doi:3201/eid2203.150977
  48. Wagenaar BH, Augusto O, Beste J, et al. The 2014-2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: time-series analyses for 2010-2016. PLoS Med. 2018;15(2):e1002508. doi:1371/journal.pmed.1002508
  49. Ammar A, Brach M, Trabelsi K, et al. Effects of COVID-19 home confinement on eating behaviour and physical activity: results of the ECLB-COVID19 international online survey. Nutrients. 2020;12(6):1583. doi:3390/nu12061583
  50. Aura CM, Nyamweya CS, Odoli CO, et al. Consequences of calamities and their management: the case of COVID-19 pandemic and flooding on inland capture fisheries in Kenya. J Great Lakes Res. 2020;46(6):1767-1775. doi:1016/j.jglr.2020.09.007
  51. Emmanuel Awucha N, Chinelo Janefrances O, Chima Meshach A, Chiamaka Henrietta J, Ibilolia Daniel A, Esther Chidiebere N. Impact of the COVID-19 pandemic on consumers' access to essential medicines in Nigeria. Am J Trop Med Hyg. 2020;103(4):1630-1634. doi:4269/ajtmh.20-0838
  52. Ceballos F, Kannan S, Kramer B. Impacts of a national lockdown on smallholder farmers’ income and food security: empirical evidence from two states in India. World Dev. 2020;136:105069. doi:1016/j.worlddev.2020.105069
  53. Yeasmin S, Banik R, Hossain S, et al. Impact of COVID-19 pandemic on the mental health of children in Bangladesh: a cross-sectional study. Child Youth Serv Rev. 2020;117:105277. doi:1016/j.childyouth.2020.105277
  54. Sama BK, Kaur P, Thind PS, Verma MK, Kaur M, Singh DD. Implications of COVID-19-induced nationwide lockdown on children's behaviour in Punjab, India. Child Care Health Dev. 2021;47(1):128-135. doi:1111/cch.12816
  55. Hogan AB, Jewell BL, Sherrard-Smith E, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Glob Health. 2020;8(9):e1132-e1141. doi:1016/s2214-109x(20)30288-6
  56. Gichuna S, Hassan R, Sanders T, Campbell R, Mutonyi M, Mwangi P. Access to healthcare in a time of COVID-19: sex workers in crisis in Nairobi, Kenya. Glob Public Health. 2020;15(10):1430-1442. doi:1080/17441692.2020.1810298
  57. Kolie D, Camara BS, Delamou A, et al. The Ebola-effect in Guinea 2014-15: tangled trends of malaria care in children under-five. PLoS One. 2018;13(2):e0192798. doi:1371/journal.pone.0192798
  58. Hung YW, Law MR, Cheng L, et al. Impact of a free care policy on the utilisation of health services during an Ebola outbreak in the Democratic Republic of Congo: an interrupted time-series analysis. BMJ Glob Health. 2020;5(7):e002119. doi:1136/bmjgh-2019-002119
  59. Carias C, Greening B, Jr., Campbell CG, Meltzer MI, Hamel MJ. Preventive malaria treatment for contacts of patients with Ebola virus disease in the context of the west Africa 2014-15 Ebola virus disease response: an economic analysis. Lancet Infect Dis. 2016;16(4):449-458. doi:1016/s1473-3099(15)00465-x
  60. Siekmans K, Sohani S, Boima T, Koffa F, Basil L, Laaziz S. Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia. BMC Public Health. 2017;17(1):84. doi:1186/s12889-016-4012-y
  61. Chandir S, Siddiqi DA, Mehmood M, et al. Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: an analysis of provincial electronic immunization registry data. Vaccine. 2020;38(45):7146-7155. doi:1016/j.vaccine.2020.08.019
  62. Sun X, Samba TT, Yao J, et al. Impact of the Ebola outbreak on routine immunization in western area, Sierra Leone - a field survey from an Ebola epidemic area. BMC Public Health. 2017;17(1):363. doi:1186/s12889-017-4242-7
  63. Salama M, Ataman-Millhouse L, Braham M, et al. Installing oncofertility programs for common cancers in limited resource settings (Repro-Can-OPEN Study): an extrapolation during the global crisis of coronavirus (COVID-19) pandemic. J Assist Reprod Genet. 2020;37(7):1567-1577. doi:1007/s10815-020-01821-7
  64. Takahashi S, Metcalf CJ, Ferrari MJ, et al. Reduced vaccination and the risk of measles and other childhood infections post-Ebola. Science. 2015;347(6227):1240-1242. doi:1126/science.aaa3438
  65. Abbas K, Procter SR, van Zandvoort K, et al. Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection. Lancet Glob Health. 2020;8(10):e1264-e1272. doi:1016/s2214-109x(20)30308-9
  66. Saleem T, Sheikh N, Abbasi MH, Javed I, Khawar MB. COVID-19 containment and its unrestrained impact on epilepsy management in resource-limited areas of Pakistan. Epilepsy Behav. 2020;112:107476. doi:1016/j.yebeh.2020.107476
  67. Chelo D, Mekone Nkwelle I, Nguefack F, et al. Decrease in hospitalizations and increase in deaths during the COVID-19 epidemic in a pediatric Hospital, Yaounde-Cameroon and prediction for the coming months. Fetal Pediatr Pathol. 2021;40(1):18-31. doi:1080/15513815.2020.1831664
  68. Delamou A, Ayadi AME, Sidibe S, et al. Effect of Ebola virus disease on maternal and child health services in Guinea: a retrospective observational cohort study. Lancet Glob Health. 2017;5(4):e448-e457. doi:1016/s2214-109x(17)30078-5
  69. Kc A, Gurung R, Kinney MV, et al. Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study. Lancet Glob Health. 2020;8(10):e1273-e1281. doi:1016/s2214-109x(20)30345-4
  70. Hamadani JD, Hasan MI, Baldi AJ, et al. Immediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: an interrupted time series. Lancet Glob Health. 2020;8(11):e1380-e1389. doi:1016/s2214-109x(20)30366-1
  71. Sharma AJ, Subramanyam MA. A cross-sectional study of psychological wellbeing of Indian adults during the COVID-19 lockdown: different strokes for different folks. PLoS One. 2020;15(9):e0238761. doi:1371/journal.pone.0238761
  72. Ammar A, Chtourou H, Boukhris O, et al. COVID-19 home confinement negatively impacts social participation and life satisfaction: a worldwide multicenter study. Int J Environ Res Public Health. 2020;17(17):6237. doi:3390/ijerph17176237
  73. Darvishi E, Golestan S, Demehri F, Jamalnia S. A cross-sectional study on cognitive errors and obsessive-compulsive disorders among young people during the outbreak of coronavirus disease 2019. Act Nerv Super (2007). 2020:1-6. doi:1007/s41470-020-00077-x
  74. Challenges for work-life balance during COVID-19 induced nationwide lockdown: exploring gender difference in emotional exhaustion in the Indian setting. Gend Manag. 2020;35(7-8):705-718. doi:10.1108/gm-06-2020-0163
  75. Abdul Mottaleb K, Mainuddin M, Sonobe T. COVID-19 induced economic loss and ensuring food security for vulnerable groups: Policy implications from Bangladesh. PLoS One. 2020;15(10):e0240709. doi:1371/journal.pone.0240709
  76. Mathew N, Deborah I, Karonga T, Rumbidzai C. The impact of COVID-19 lockdown in a developing country: narratives of self-employed women in Ndola, Zambia. Health Care Women Int. 2020;41(11-12):1370-1383. doi:1080/07399332.2020.1823983
  77. Lipsitch M, Swerdlow DL, Finelli L. Defining the epidemiology of COVID-19 - studies needed. N Engl J Med. 2020;382(13):1194-1196. doi:1056/NEJMp2002125
  78. Álvarez-Gálvez J, Rodero-Cosano ML, Salinas-Pérez JA, Gómez-Baya D. Exploring the complex associations among social determinants of health in Andalusia after the 2008 financial crisis. Soc Indic Res. 2019;141(2):873-893. doi:1007/s11205-018-1845-z
  79. Bowser D, Gupta J, Nandakumar A. The effect of demand- and supply-side health financing on infant, child, and maternal mortality in low- and middle-income countries. Health Syst Reform. 2016;2(2):147-159. doi:1080/23288604.2016.1166306
  80. Gordon T, Booysen F, Mbonigaba J. Socio-economic inequalities in the multiple dimensions of access to healthcare: the case of South Africa. BMC Public Health. 2020;20(1):289. doi:1186/s12889-020-8368-7
  81. Feikin DR, Flannery B, Hamel MJ, Stack M, Hansen PM. Vaccines for children in low- and middle-income countries. In: Black RE, Laxminarayan R, Temmerman M, Walker N, eds. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). The International Bank for Reconstruction and Development, The World Bank; 2016. http://www.ncbi.nlm.nih.gov/books/NBK361927/. Accessed January 20, 2021.
  82. Briozzo L, Tomasso G, Viroga S, Nozar F, Bianchi A. Impact of mitigation measures against the COVID 19 pandemic on the perinatal results of the reference maternity hospital in Uruguay. J Matern Fetal Neonatal Med. 2021:1-3. doi:1080/14767058.2021.1874911
  83. Di Renzo L, Gualtieri P, Pivari F, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18(1):229. doi:1186/s12967-020-02399-5
  84. Medline A, Hayes L, Valdez K, et al. Evaluating the impact of stay-at-home orders on the time to reach the peak burden of COVID-19 cases and deaths: does timing matter? BMC Public Health. 2020;20(1):1750. doi:1186/s12889-020-09817-9
  85. Elliott JH, Synnot A, Turner T, et al. Living systematic review: 1. Introduction-the why, what, when, and how. J Clin Epidemiol. 2017;91:23-30. doi:1016/j.jclinepi.2017.08.010
  86. Siemieniuk RA, Bartoszko JJ, Ge L, et al. Drug treatments for covid-19: living systematic review and network meta-analysis. BMJ. 2020;370:m2980. doi:1136/bmj.m2980

Articles in Press, Corrected Proof
Available Online from 07 November 2021
  • Receive Date: 20 February 2021
  • Revise Date: 11 October 2021
  • Accept Date: 06 November 2021
  • First Publish Date: 07 November 2021