The Prevalence of Methicillin-resistantStaphylococcus aureusin Clinical Settings of Pakistan: A Systematic Review and Meta-Analysis

BACKGROUND: Multimorbidity is increasing over time and causes a major global health challenge among individuals with type 2 diabetes (T2D). The growing prevalence of multimorbidity coupled with its complex management leads to a significant concern for the healthcare system. Evidence of existing studies on multimorbidity showed inconsistencies across different regions in the world. This study aimed to summarize and estimate the pooled global prevalence of multimorbidity and its associated factors among patients with T2D. METHODS: A systematic review and meta-analysis were conducted, including studies up to January 2025. PubMed, HINARI, CINAHL/EBSCO, the Cochrane Library, ProQuest, Google Scholar, and Google were used to search studies. The quality of the selected articles was evaluated using the Joanna Briggs Institute (JBI) checklist. The pooled prevalence was estimated using a random effect model with a 95% confidence interval (CI), while a fixed effect model was used to assess the pooled adjusted odds ratios (AORs) for the exposure variables. Heterogeneity was assessed using I² statistics and Cochran’s Q test (p-value). Subgroup analysis and meta-regression were used to identify the sources of variation. Publication bias was assessed using a funnel plot and Egger’s test (p-value < 0.05). RESULTS: In this review, a total of 32 studies and 2,934,500 participants were included. The pooled global prevalence of multimorbidity among T2D was 83.17%, concordant conditions (related to T2D) was 50.21%, discordant conditions (unrelated to T2D) was 47.24%, and combined conditions (having both chronic conditions) was 58.90%. Age 40–59 years (AOR = 2.36, 95% CI: 1.17–3.55), being retired (AOR = 1.31, 95% CI: 0.96–1.66), non-formal education (AOR = 2.93, 95% CI: 1.44–4.42), being widowed (AOR = 2.00, 95% CI: 1.04–2.96), and being a current smoker (AOR = 2.33, 95% CI: 1.16–3.50) were the predictors of multimorbidity. Being an urban resident (AOR: 1.69, 95% CI: 0.95–2.44) was associated with concordant chronic conditions. CONCLUSIONS: Multimorbidity is highly prevalent among type 2 diabetes, emphasizing a major public health challenge. It is important to develop a well-designed and comprehensive strategy to enhance the prevention and management of multimorbidity. Particular emphasis should be given to older adults, people who have a low level of education, retired individuals, smokers, widowed individuals, and people living in urban residences. TRIAL REGISTRATION: PROSPERO-CRD42025639310. Registered on January 16/2025.

BackgroundAlthough venous thromboembolism (VTE) is a recognized side effect of some formulations of estrogen therapy, its impact in transgender people remains uncertain. The aim of this study was to define pooled prevalence estimate and correlates of VTE in Assigned Males at Birth (AMAB) trans people undergoing gender affirming hormone therapy.MethodsA thorough search of MEDLINE, COCHRANE LIBRARY, SCOPUS and WEB OF SCIENCE databases was carried out to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effects models and the between-study heterogeneity was assessed by the Cochrane’s Q and I2.ResultsThe eighteen studies included gave information about 11,542 AMAB undergoing gender affirming hormone therapy. The pooled prevalence of VTE was 2% (95%CI:1-3%), with a large heterogeneity (I2 = 89.18%, P<0.0001). Trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimate. At the meta-regression analysis, a higher prevalence of VTE was significantly associated with an older age (S=0.0063; 95%CI:0.0022,0.0104, P=0.0027) and a longer length of estrogen therapy (S=0.0011; 95%CI:0.0006,0.0016, P<0.0001). When, according to the meta-regression results, the analysis was restricted to series with a mean age ≥37.5 years, the prevalence estimate for VTE increased up to 3% (95%CI:0-5%), but with persistence of a large heterogeneity (I2 = 88,2%, P<0.0001); studies on younger participants (<37.5 years) collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-2%) with no heterogeneity (I2 = 0%, P=0.97). Prevalence estimate for VTE in series with a mean length of estrogen therapy ≥53 months was 1% (95%CI:0-3%), with persistent significant heterogeneity (I2 = 84,8%, P=0.0006); studies on participants subjected to a shorter length of estrogen therapy (<53 months), collectively produced a pooled VTE prevalence estimate of 0% (95%CI:0-3%) with no heterogeneity (I2 = 0%, P=0.76).ConclusionsThe overall rate of VTE in AMAB trans people undergoing gender affirming hormone therapy was 2%. In AMAB population with <37.5 years undergoing estrogen therapy for less than 53 months, the risk of VTE appears to be negligible. Further studies are warranted to assess whether different types and administration routes of estrogen therapy could decrease the VTE risk in AMAB trans people over 37.5 years subjected to long-term therapy.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021229916].

Adolescents have higher nutrient requirements than adults, as this stage accounts for approximately 40% of total adult weight gain, 45% of skeletal mass and about 15% of adult height. Adequate micronutrient intake is particularly essential for adolescent girls to support growth, reproductive health, and cognitive development. Adolescent folate deficiency disrupts hematopoiesis, causing megaloblastic anemia, and hinders growth, cognition, and immune function and becoming a major public health concern. This global systematic review and meta-analysis aims to address the gap in comprehensive evidence on the prevalence of adolescent folate deficiency. This systematic review was conducted and reported according to PRISMA guidelines. We conducted a systematic literature search in PubMed, HINARI,Science Direct, DOAJ, Google, and Google Scholar for studies reporting the prevalence of folate deficiency among adolescent girls up to August 2025. Study quality was assessed using the Newcastle-Ottawa Scale, and evidence certainty was evaluated using GRADE. Pooled prevalence estimates with 95% confidence intervals were calculated using a random-effects model (DerSimonian-Laird method). Heterogeneity was assessed with Cochrane Q and I² statistics. Publication bias was evaluated through visual inspection of funnel plots and Egger's regression test, and adjusted estimates were calculated using the trim-and-fill method. Meta-regression analyses were conducted to explore potential sources of heterogeneity. Sensitivity analyses were performed to assess the robustness of pooled estimates. The search strategy identified 1,498 records, of which 26 studies met the eligibility criteria and were included in this systematic review andmeta-analysis. The pooled global prevalence of folate deficiency among adolescent girls was 26.9%(95% CI: 20.5-33.2), with substantial heterogeneity observed between studies (I² = 99.99%, p < 0.001). On average across included studies, approximately one-quarter of adolescent girls were classified as folate deficient, though the true prevalence varied markedly between settings.. The pooled prevalence of folate deficiency among adolescent girls varied across regions, with the highest rate observed in Africa at 35.5%. These findings revealed folate deficiency as a substantial global public health concern among adolescent girls with a disproportionately high burden in low-resource settings. Region-specific strategies are urgently needed to prevent folate deficiency among adolescent girls, particularly in low-resource settings. Implementing targeted nutritional interventions and public health policies is essential to reduce its associated health consequences in this vulnerable population.

Internet Gaming Disorder (IGD) has emerged as a significant behavioral concern among youth, yet global prevalence estimates remain inconsistent due to methodological variability. This systematic review and meta-analysis aimed to determine the global pooled prevalence of IGD in children and adolescents. Following PRISMA 2020 guidelines and prospective registration in PROSPERO (CRD420251156483) prior to data extraction and analysis, comprehensive searches were conducted in PubMed, Scopus, Web of Science, Embase, and PsycINFO up to September 2025. Eligible observational studies assessed IGD prevalence in individuals aged 6-18 years using standardized diagnostic instruments based on DSM-5 or ICD-11 criteria. A random-effects meta-analysis (DerSimonian and Laird method) with Freeman-Tukey double arcsine transformation was used to pool prevalence estimates. Between-study heterogeneity was quantified using the I² statistic, and publication bias was assessed using funnel plot asymmetry and Egger's regression test. Nineteen studies involving 251,037 participants and 26,868 IGD cases met the inclusion criteria. The pooled global prevalence of IGD among children and adolescents was 10% (95% CI: 6-15%). Individual study estimates ranged from approximately 1% in some European populations to over 25% in studies conducted in Middle Eastern and Latin American settings. Heterogeneity was extreme (I² = 99.7%), and smaller studies tended to report higher prevalence. Approximately one in ten children and adolescents worldwide meet criteria for IGD, underscoring its growing significance as a global mental health concern. Given the substantial heterogeneity observed, the pooled estimate should be interpreted as an average across diverse contexts rather than a uniform global rate. These findings highlight the need for standardized diagnostic criteria, culturally sensitive preventive interventions, and early identification strategies to mitigate long-term psychosocial impact.

ObjectiveTo estimate the pooled prevalence of multimorbidity (≥2 non-communicable diseases in the same individual) among adults of the general population of Latin American and the Caribbean (LAC).DesignSystematic review and meta-analysis.Data...

BackgroundOne of the main threats to public health today is antibiotic resistance. This resistance leads to the persistence of infections in the body. It poses an increased risk of transmission to humans and animals through various routes, such as food, water, and the environment.ObjectivesThis study aimed to ascertain the overall prevalence of knowledge, attitudes, and practices regarding antimicrobial resistance in Africa.MethodsA systematic review and meta-analysis of published and unpublished studies was conducted in Africa according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were conducted using appropriate search terms in PubMed, Web of Science, Science Direct, Google Scholar, African Journals Online, and the Cochrane Library. Data were extracted using Microsoft Excel, and STATA version 14 was used for analysis. Publication bias was checked by funnel plot, Egger, and Begg regression tests. A p-value of 0.05 was regarded to indicate potential publication bias. Using I2 statistics, the heterogeneity of the studies was evaluated. Using forest plots, the random effect model was used to present the pooled prevalence with a 95% confidence interval (CI) of meta-analysis.ResultsThis review included 39 studies, with 18,769 study participants. Among these 39 studies, 38 were on knowledge assessment, 28 on attitude assessment, and 25 on good practice assessment towards antimicrobial resistances. The overall pooled prevalence level of knowledge regarding antimicrobial resistance in Africa was 55.33% (95% CI: 47.48, 63.18). The overall pooled prevalence of positive attitudes toward antimicrobial resistance in Africa was 46.93% (95% CI: 35.10, 58.76), and the overall pooled prevalence of good practice of antimicrobial resistance in Africa was 51.05% (95% CI: 45.24, 56.87). In addition, sub-group statistical analysis was performed in this meta-analysis, stratified by population sub-region and study design types.ConclusionIn Africa, the pooled prevalence of knowledge, attitudes, and practices regarding antimicrobial drug resistance among different groups, including the general population, patients, tertiary school students, healthcare workers, and animal owners was found to be low level. Therefore, it is imperative to enhance the education and training programs regarding antibiotic resistance for various groups including the general public, patients, students, healthcare workers, and individuals responsible for the well-being of animals.

Excessive and improper use of antibiotics causes antimicrobial resistance which is a major threat to global health security. Hospitals in sub-Saharan Africa (SSA) has the highest prevalence of antibiotic use. This systematic review and meta-analysis aimed to determine the pooled point prevalence (PPP) of evidence-based antimicrobial use among hospitalized patients in SSA. Literature was retrieved from CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science databases. Meta-analysis was conducted using STATA version 17. Forest plots using the random-effect model were used to present the findings. The heterogeneity and publication bias were assessed using the I2 statistics and Egger’s test. The protocol was registered in PROSPERO with code CRD42023404075. The review was conducted according to PRISMA guidelines. A total of 26, 272 study participants reported by twenty-eight studies published from 10 countries in SSA were included. The pooled point prevalence of antimicrobial use in SSA were 64%. The pooled estimate of hospital wards with the highest antibiotic use were intensive care unit (89%). The pooled prevalence of the most common clinical indication for antibiotic use were community acquired infection (41%). The pooled point prevalence of antimicrobial use among hospitalized patients were higher in SSA. Higher use of antibiotics was recorded in intensive care units. Community acquired infection were most common clinical case among hospitalized patients. Health systems in SSA must design innovative digital health interventions to optimize clinicians adhere to evidence-based prescribing guidelines and improve antimicrobial stewardship.

Globally, macrosomia affects 3 to 15% of all pregnancies; there is a global variation in the magnitude of macrosomia among countries. It is one of the public health problems in most developing countries and contributes to maternal and newborn complications. There are some inconsistent individual studies done in Ethiopia, but there is no current pooled national data on its prevalence and factors associated with it. So the study will be used to design and implement a well-comprehensive intervention targeting maternal and child health services. To estimate the pooled prevalence and associated factors of fetal macrosomia in Ethiopia. A systematic review and Meta-analysis of published and grey literature was conducted. A Web of Science, EMBASE, PubMed, Scopus, African Journals Online and Elsevier Science direct were searched as electronic databases, while Google Scholar was utilized as a supplementary search engine. Joanna Briggs Institute (JBI) quality appraisal tools were used for quality assessment and the study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to maintain scientific robustness. Statistical analyses were performed using STATA software (version 14). For each identified associated factor, pooled effect sizes, 95% confidence intervals and measures of statistical heterogeneity were calculated. Heterogeneity among the included studies was quantified using I2 statistic where a value greater than 50% indicated substantial heterogeneity. Potential sources of heterogeneity were explored using meta-regression, sensitivity analysis, and subgroup analysis. Either random-effects or fixed-effect models were employed based on the observed level of heterogeneity. Potential publication bias was assessed using funnel plots and Egger's regression test. Statistical significance was declared at a p-value less than 0.05 with a 95% CI. A total of 4309 neonates were delivered in Ethiopian Health institutions, from which 3670 singleton births were included to estimate the pooled effect of fetal macrosomia. The pooled prevalence of fetal macrosomia among delivered neonates in Ethiopia was 10.84% (95% CI: 6.38%-15.31%). Regionally, the highest and lowest pooled estimates were reported from Tigray (13.24%) and Amhara region (7.41%) respectively. Significant heterogeneity was observed across the pooled effect (I2= 71.6%, P-value = 0.004) 95% CI. Subgroup analysis by year revealed that the pooled estimate of macrosomia before and after 2019 was 12.31% and 7.42%, respectively. Meta-regression indicated that this heterogeneity was not significantly driven by sample size (p = 0.08), geographic region (SNNP: p = 0.558, Tigray: p = 0.30, Amhara: p = 0.150), or publication year (p = 0.20). Sensitivity analysis was conducted to evaluate individual study effects; the pooled estimate fluctuated between 9.1% and 12.35%, indicating no single study disproportionately influenced the overall result. In the random-effects meta-analysis, five potential determinants were evaluated; however, none demonstrated a statistically significant pooled association due to marked statistical imprecision. The pooled adjusted odds ratios were as follows: Previous history of macrosomia.(AOR = 4.23, 95%CI, 0.334-53.668), being male(AOR = 2.32, 95%CI, 0.40-13.33), physical inactivity (AOR = 3.014, 95%CI, 0.229-39.614), weight gain during pregnancy((AOR = 4.88, 95%CI, 0.169-140.97), and higher gestational age (AOR = 4.71, 95%CI, 0.47-46.28). Fetal macrosomia represents a notable public health concern in Ethiopia, with a pooled prevalence exceeding multiple Sub-Saharan regional reports. Because pooled exposure analyses were highly underpowered and statistically non-significant, routine clinical screening during antenatal care should be strengthened, and larger prospective cohort studies are required to establish precise national risk pathways.

Performing and evaluating meta-analyses

Hepatitis B virus (HBV) is one of the major public health problems globally and needs an urgent response. It is one of the most responsible causes of mortality among the five hepatitis viruses, and it affects almost every class of individuals. Different studies were conducted on the prevalence of HBV among pregnant women in East African countries, but none of them showed the pooled prevalence of HBV among the pregnant women. Thus, the main objective of this study was to determine the pooled prevalence and its determinants among pregnant women in East Africa. We searched studies using PubMed, Scopus, Embase, ScienceDirect, Google Scholar and grey literature that were published between January 01/2020 to January 30/2024. The studies were assessed using the Newcastle Ottawa Scale (NOS) quality assessment scale. The random-effect (DerSimonian) model was used to determine the pooled prevalence and associated factors of HBV among pregnant women. Heterogeneity were assessed by I2 statistic, sub-group analysis, and sensitivity analysis. Publication bias was assessed by Egger test, and the analysis was done using STATA version 17. A total of 45 studies with 35639 pregnant women were included in this systematic review and meta-analysis. The overall pooled prevalence of HBV among pregnant women in East Africa was 6.0% (95% CI: 6.0%-7.0%, I2 = 89.7%). The highest prevalence of 8% ((95% CI: 6%, 10%), I2 = 91.08%) was seen in 2021, and the lowest prevalence 5% ((95% CI: 4%, 6%) I2 = 52.52%) was observed in 2022. A pooled meta-analysis showed that history of surgical procedure (OR = 2.14 (95% CI: 1.27, 3.61)), having multiple sexual partners (OR = 3.87 (95% CI: 2.52, 5.95), history of body tattooing (OR = 2.55 (95% CI: 1.62, 4.01)), history of tooth extraction (OR = 2.09 (95% CI: 1.29, 3.39)), abortion history(OR = 2.20(95% CI: 1.38, 3.50)), history of sharing sharp material (OR = 1.88 (95% CI: 1.07, 3.31)), blood transfusion (OR = 2.41 (95% CI: 1.62, 3.57)), family history of HBV (OR = 4.87 (95% CI: 2.95, 8.05)) and history needle injury (OR = 2.62 (95% CI: 1.20, 5.72)) were significant risk factors associated with HBV infection among pregnant women. The pooled prevalence of HBV infection among pregnant women in East Africa was an intermediate level and different across countries ranging from 1.5% to 22.2%. The result of this pooled prevalence was an indication of the need for screening, prevention, and control of HBV infection among pregnant women in the region. Therefore, early identification of risk factors, awareness creation on the mode of transmission HBV and implementation of preventive measures are essential in reducing the burden of HBV infection among pregnant women.

BackgroundAnemia is one of the global public health problems that affect more than one third of the world population. It has been strongly associated with poor growth and development, limited psychomotor development, and poor long-term performance in cognitive, social, and emotional functioning in children. There is not a single national figure about childhood anemia in Ethiopia. There is also inconclusive evidence about factors associated with anemia. Moreover, the present meta-analysis will generate concrete evidence in which the result may urge policy makers and program managers to design appropriate intervention to control childhood anemia. Thus, the aim of this review is to estimate the pooled prevalence and to identify associated factors of anemia among children in Ethiopia.MethodPublished relevant cross-sectional studies will be searched using comprehensive search strings through PubMed/Medline, SCOPUS, HINARI, EMBASE, Web of Science databases. In addition, Google Scholar and Google will be searched for grey literature.Reference lists and communication with content experts will be used to get additional relevant studies. Two groups of review authors will independently appraise the studies for scientific quality and extract the data using the Joanna Briggs Institute (JBI) tools. The pooled estimate will be determined using random effect model. Heterogeneity between the studies will be assessed using the I2 statistics. Sensitivity and subgroup analysis will be employed in the case of heterogeneity. Publication bias will be assessed by visual inspection of the funnel plot, and using Egger’s and Begg’s statistical tests.DiscussionChildhood anemia is known to have negative consequences on mental, physical and social development of children. The burden and its associated factors are greatly varied as to the social, economic, and geographical differences of the target population.Therefore, the proposed systematic review will generate evidence about the pooled prevalence of anemia and its associated factors among children in Ethiopia.Protocol registrationThe protocol was registered at PROSPERO International Prospective Register of Systematic Reviews.(Registration number: CRD42018088223).

Introduction This meta-analysis was conducted to estimate the prevalence of hypothyroidism among pregnant women in India. Methods We searched PubMed, Web of Science, Scopus, Google Scholar, and Shodhganga (Indian thesis repository) for observational studies, providing prevalence of hypothyroidism among pregnant women in India. Systematic study selection and data extraction procedures were followed. Quality assessment of each study was done using JBI critical appraisal checklist. The random effects model was used for pooling the effect sizes. Publication bias was assessed using the funnel plot and rank correlation test. I2 statistics was used to measure heterogeneity across the studies. Heterogeneity in the pooled estimates was further explored with subgroup analyses and meta-regression analysis. Results Sixty-one studies were found eligible and included in this review. The pooled estimate of the prevalence of hypothyroidism in pregnant women was 11.07% (95% CI: 8.79–13.84, I2 = 99%). Pooled prevalence estimates of subclinical and overt hypothyroidism are 9.51% (95% CI: 7.48–12.04, I2 = 98%) and 2.74% (95% CI: 2.08–3.58, I2 = 94%). Conclusion We documented 11.07% pooled prevalence of hypothyroidism in pregnant women in India.

IntroductionSuicide is a major public health problem and one of the top causes of death among adolescents worldwide. The Ethiopian government works to ensure healthy lives and promote well-being in adolescents through the National Adolescent and Youth Mental Health Strategy. Despite these efforts, suicide in adolescents remains pressing in Ethiopia; however, study findings regarding suicidal ideation and suicide attempts and their associated factors in high school adolescents have been inconsistent and non-conclusive. Therefore, this review aimed to assess the pooled national prevalence and risk factors of suicidal ideation and suicide attempts among high school adolescents in Ethiopia.MethodsThe Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guideline was followed for this systematic review. We searched PubMed, Embase, ScienceDirect, and Google Scholar databases. We included all observational studies that report the prevalence and associated factors of suicidal ideation and suicide attempts among high school adolescents in Ethiopia. Using a standard data extraction format, two authors separately extracted all required data. The meta-analysis was conducted using Stata version 17 statistical software. The Cochrane Q test and I² statistics were employed to evaluate the heterogeneity among the included studies. Pooled prevalence estimates, along with their 95% confidence intervals, were calculated using a random-effects model. Potential sources of heterogeneity across studies were further explored through subgroup analyses, sensitivity analysis, and meta-regression analysis.ResultThe review comprised ten studies with 8,620 participants. Out of 1,451 studies identified, 10 studies were included in the analysis. As the random effect model indicated that the pooled prevalence of suicide ideation and suicide attempt among high school adolescents in Ethiopia was 16% (95% CI: 12%, 19%) and 10% (95% CI: 6%, 13%), respectively. The highest prevalence of suicidal ideation was observed after the country’s implementation of HSTP II [18 (95% CI: 15–22), I²=83.94, P-value < 0.001], while the lowest prevalence was depicted in adolescents aged 10–19 years [11% (95% CI 10, 13), I²=93.3, P-value < 0.001]. Similarly, the highest pooled prevalence of suicide attempt was observed after the country’s implementation of HSTP II [12% (95% CI: 10–13), I²=67.77, P-value < 0.03], while the lowest prevalence was depicted in adolescents aged 10–19 years [5% (95% CI 1, 9), I²=94.43, P-value < 0.001]. The sensitivity analysis indicated that none of the point estimates were outside of the overall 95% confidence interval. No publication bias was seen in suicide ideation. But evidence of publication bias for suicide attempts was identified through the left trim and fill analysis. Gender, disappointment with school results, family history, alcohol use, the presence or absence of family or social support, history of abuse, living arrangement of adolescent, anxiety, and depression were significantly associated with suicide ideation and suicide attempts among high school adolescents in Ethiopia.ConclusionThis review revealed that a significant proportion of high school adolescents had suicidal ideation and suicide attempts in Ethiopia. Therefore, the government and all stakeholders should track the outcome of the suicide prevention project under HSTP II and other initiatives. In addition, emphasis should be given to disadvantaged adolescents, including females, orphans, alcohol users, and mentally challenged adolescents. Furthermore, school-based interventions like social support and suicide prevention initiatives shall be promoted.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial lung disease. Anxiety and depression are prevalent psychiatric comorbidities among IPF patients; however, reported prevalence rates vary substantially, and a consolidated estimate is lacking. This systematic review and meta-analysis aimed to determine the global pooled prevalence of anxiety and depression in IPF patients and to explore potential sources of heterogeneity, thus providing a robust evidence base for clinical management and future research. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic literature search was conducted in PubMed, Web of Science, Cochrane Library, and Embase from database inception to October 23, 2025, to identify studies reporting the prevalence of anxiety or depression in patients with IPF. Two reviewers independently screened the literature, extracted data, and assessed the methodological quality of the included studies using the Joanna Briggs Institute (JBI) critical appraisal checklist. Two separate single-arm meta-analyses were performed, one for studies using International Classification of Diseases, Tenth Revision (ICD-10) criteria and one for those using screening tools (e.g., Hospital Anxiety and Depression Scale, Patient Health Questionnaire-9). Pooled prevalence estimates were calculated using a generalized linear mixed model (GLMM), with corresponding 95% confidence intervals (CIs) and 95% prediction intervals (PIs). Heterogeneity was assessed using Cochran's Q test, the I² statistic, and τ². Sensitivity analyses were conducted using the leave-one-out method and the Freeman-Tukey double arcsine transformation. Subgroup analyses were performed based on study design, geographic region, assessment tool, methodological quality, and sample size. Publication bias was evaluated using Doi plots and the LFK index. A total of 25 studies involving 78,060 IPF patients were included. Among these, 15 studies reported the prevalence of anxiety and 25 reported the prevalence of depression. Studies that did not specify the assessment tool were excluded from the meta-analysis, resulting in the inclusion of 14 studies for the anxiety meta-analysis and 18 studies for the depression meta-analysis. Quantitative analyses were performed separately for the ICD-10 group and the screening tool group. Anxiety in IPF: The pooled prevalence was 14.52% (95% CI: 8.90%-22.79%) in the ICD-10 group (2 studies), with substantial heterogeneity (τ² = 0.1599, I² = 98.9%, P < 0.001); the 95% PI was not calculated due to the small number of studies. In the screening tool group (12 studies), the pooled prevalence was 42.04% (95% CI: 25.28%-60.86%), with a 95% PI of 3.36%-93.80% and substantial heterogeneity (τ² = 1.7068, I² = 88.3%, P < 0.001). Depression in IPF: The pooled prevalence was 6.87% (95% CI: 3.23%-14.04%) in the ICD-10 group (3 studies), with a 95% PI of 0.00%-99.95% and substantial heterogeneity (τ² = 0.4853, I² = 99.8%, P < 0.001). In the screening tool group (15 studies), the pooled prevalence was 38.26% (95% CI: 24.65%-54.01%), with a 95% PI of 3.89%-90.46% and substantial heterogeneity (τ² = 1.4877, I² = 82.3%, P < 0.001). Subgroup analyses based on the screening tool group showed no statistically significant differences in pooled prevalence across study design, assessment tool, geographic region, methodological quality, or sample size (all P > 0.05). Sensitivity analyses confirmed the robustness of the pooled estimates for both anxiety and depression. Publication bias assessment revealed significant bias in the screening tool groups for both outcomes. The prevalence of anxiety and depression in IPF patients is substantial and is significantly influenced by the assessment tool used: estimates based on ICD-10 clinical diagnoses are substantially lower than those derived from screening tools. Therefore, future large-scale, high-quality studies employing standardized assessment tools are needed to accurately evaluate the psychiatric comorbidity burden in IPF patients, thereby providing robust evidence for the development of targeted clinical intervention strategies. PROSPERO; No.: CRD420251174885.

Mpox remains a public health emergency of international concern, especially in regions beyond its usual endemic areas in Africa. Assessing healthcare workers good knowledge and positive attitudes is essential for effective prevention and control efforts. This systematic review and meta-analysis aim to determine the pooled good knowledge and positive attitudes toward mpox among healthcare workers in Sub-Saharan Africa after the 2022 outbreak. We searched major databases for relevant studies published up to June 25, 2025. Studies reporting knowledge and/or attitudes toward mpox were included. Study quality was assessed using a standardized appraisal tool, and heterogeneity was assessed using the I2 statistic. Data were extracted using a standardized protocol, and a random-effects model was used to calculate pooled prevalence estimates with 95% confidence intervals. The meta-analysis included sixteen and eight studies in knowledge and attitude analyses, respectively, to estimate the pooled prevalence. The pooled prevalence of good knowledge and positive attitudes toward monkeypox was 45.3% (95% CI: 36.8, 53.9) and 53.8% (95% CI: 43.0, 64.7), respectively. Significant heterogeneity was observed across studies; however, both statistical tests (Egger's test, p = 0.14; Begg's test, p = 0.19) indicated no significant publication bias. The good knowledge and positive attitudes of healthcare workers toward mpox were low and unsatisfactory in sub-Saharan Africa. The review result underscores the need for targeted interventions to improve healthcare providers' understanding of mpox transmission, prevention, and management. Targeted educational programs and training are needed to improve the preparedness of healthcare workers for mpox outbreaks and other emerging diseases.