Table 3.
GRADE Assessment of the included studies.
| Study | Year | Risk of bias | Inconsistency | Indirectness | Imprecision | Publication bias | Overall quality of evidence |
|---|---|---|---|---|---|---|---|
| Balasubramanian et al. | 2003 | Moderate | Not serious | Serious | Serious | Undetected | Low |
| Graff et al. | 2004 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Vendt et al. | 2007 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Baroncelli et al. | 2008 | Moderate | Not serious | Serious | Serious | Undetected | Low |
| Thacher et al. | 2009 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Al-Atawi et al. | 2009 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Al-Mekhlafi et al. | 2010 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Jain et al. | 2011 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Ndemwa et al. | 2011 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Hotz et al. | 2012 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Aggarwal et al. | 2012 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Aggarwal et al. | 2013 | Low | Not serious | Serious | Moderate | Undetected | Moderate |
| Aggarwal et al. | 2013 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Al-Mekhlafi et al. | 2013 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Uijterschout et al. | 2014 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Thacher et al. | 2014 | Low | Not serious | Serious | Moderate | Undetected | Moderate |
| Wheeler et al. | 2015 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Hess et al. | 2015 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Abrha et al. | 2016 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Tariku et al. | 2016 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Van Der Kam et al. | 2016 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| El Kholy et al. | 2017 | Moderate | Not applicable / Not serious | Serious | Moderate | Undetected | Low |
| Naik et al. | 2017 | Low | Not serious | Serious | Moderate | Undetected | Moderate |
| Huybregts et al. | 2017 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Powers et al. | 2017 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Leidman et al. | 2018 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Ahmed et al. | 2020 | Moderate | Not applicable / Not serious | Serious | Moderate | Undetected | Low |
| Acoglu et al. | 2020 | Moderate | Not applicable / Not serious | Serious | Moderate | Undetected | Low |
| Trivedi et al. | 2020 | Low | Not serious | Serious | Moderate | Undetected | Moderate |
| Stewart et al. | 2020 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Yisak et al. | 2020 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Ajakaye et al. | 2020 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Nigusse et al. | 2021 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Atukunda et al. | 2021 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Williams et al. | 2021 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Abou-Rizk et al. | 2021 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Benedict et al. | 2021 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Chee et al. | 2021 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Soofi et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Dewey et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Sangalang et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Chek et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Cazes et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Daures et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Tamara et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Vilander et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Liu et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Kohl et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Taneja et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Wang et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Rashid et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Datoo et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Smith et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Alam et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Saluja et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Wangeci et al. | 2022 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Goyal et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| O’Callaghan et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Cashman et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Yadav et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Okyere et al. | 2022 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Kambale et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Lambrecht et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Grijalva-Eternod et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Hojati et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Tickell et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Cazes et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Batool et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Bhargava et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Argaw et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Nuzhat et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Dabas et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Wu et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Gora et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Roberson et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Wiafe et al. | 2023 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Jeremias et al. | 2023 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Andriani et al. | 2023 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Kirolos et al. | 2024 | Moderate | Not serious | Serious | Moderate | Undetected | Low |
| Sié et al. | 2024 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Ricci et al. | 2024 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Lautatzis et al. | 2024 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Mondal et al. | 2024 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Reyes et al. | 2024 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Ganmaa et al. | 2024 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Khalil et al. | 2024 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Bashiri et al. | 2024 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Raju et al. | 2024 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Rahman et al. | 2025 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Ow et al. | 2025 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Khadilkar et al. | 2025 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| George et al. | 2025 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Sharma et al. | 2025 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |
| Matheny et al. | 2025 | Low | Not serious | Not serious | Moderate | Undetected | Moderate |