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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 34293

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Special Issue Editors

Dr. Naomi Cano-Ibáñez

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Guest Editor

1. Department of Preventive Medicine and Public Health, University of Granada, 18011 Granada, Spain
2. CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
3. Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain
Interests: systematic reviews; meta-analysis; nutritional epidemiology; public health
Special Issues, Collections and Topics in MDPI journals

Dr. Khalid Saeed Khan

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Guest Editor

Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain
Interests: systematic reviews; meta-analysis; evidence-based medicine; diversity and inclusion in health

Special Issue Information

Dear Colleagues,

Systematic reviews provide summaries of evidence contained in a number of individual studies on a specific topic. Evidence synthesis is the general term used to describe a systematic review. Meta-analysis is a statistical technique for combining the results of a number of individual studies to produce a summary result. A systematic review may or may not deploy a meta-analysis. The logic of systematically reviewing literature is applied today in a wide variety of ways leading to a plethora of published reviews on a topic. Among other evidence synthesis types, there are meta-syntheses, scoping reviews, rapid reviews, living systematic reviews, umbrella reviews, guidelines, etc. Current healthcare practice and policy increasingly rely on clear and comprehensive summaries of information collated through systematic literature reviews. It is necessary for public health professionals to use reviews for underpinning their practice guidelines.

Research that is relevant to public health practice is scattered all over the literature and in multiple languages. Evidence synthesized through a systematic review article, aided by meta-analysis if appropriate, can offer a quick overview of a wide range of information on a particular topic. Such reviews are also frequently cited by others, particularly in the background and discussion section of their papers. We propose this Special Issue in order to bring together in one place systematic reviews on a broad range of public health topics collated from institutions and experts worldwide. Systematic reviews are carried out to generate answers to focused questions about healthcare and related issues. The key to a successful review project lies in the reviewer’s ability to prioritize a precise and specific problem to be addressed in the review.

This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) will focus on presenting the current state of public health knowledge through systematic reviews and meta-analyses.

Dr. Naomi Cano-Ibáñez
Dr. Khalid Saeed Khan
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

systematic reviews
meta-analysis
evidence synthesis
public health
evidence-based healthcare

Published Papers (11 papers)

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13 pages, 1355 KiB

Open AccessReview

Assessing the Integrity of Clinical Trials Included in Evidence Syntheses

by María Núñez-Núñez, Naomi Cano-Ibáñez, Javier Zamora, Aurora Bueno-Cavanillas and Khalid Saeed Khan

Int. J. Environ. Res. Public Health 2023, 20(12), 6138; https://doi.org/10.3390/ijerph20126138 - 15 Jun 2023

Cited by 4 | Viewed by 2599

Abstract

Evidence syntheses of randomized clinical trials (RCTs) offer the highest level of scientific evidence for informing clinical practice and policy. The value of evidence synthesis itself depends on the trustworthiness of the included RCTs. The rising number of retractions and expressions of concern about the authenticity of RCTs has raised awareness about the existence of problematic studies, sometimes called “zombie” trials. Research integrity, i.e., adherence to ethical and professional standards, is a multi-dimensional concept that is incompletely evaluated for the RCTs included in current evidence syntheses. Systematic reviewers tend to rely on the editorial and peer-review system established by journals as custodians of integrity of the RCTs they synthesize. It is now well established that falsified and fabricated RCTs are slipping through. Thus, RCT integrity assessment becomes a necessary step in systematic reviews going forward, in particular because RCTs with data-related integrity concerns remain available for use in evidence syntheses. There is a need for validated tools for systematic reviewers to proactively deploy in the assessment of integrity deviations without having to wait for RCTs to be retracted by journals or expressions of concern issued. This article analyzes the issues and challenges in conducting evidence syntheses where the literature contains RCTs with possible integrity deficits. The way forward in the form of formal RCT integrity assessments in systematic reviews is proposed, and implications of this new initiative are discussed. Future directions include emphasizing ethical and professional standards, providing tailored integrity-specific training, and creating systems to promote research integrity, as improvements in RCT integrity will benefit evidence syntheses. Full article

(This article belongs to the Special Issue Systematic Reviews and Meta-Analyses in Public Health)

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17 pages, 945 KiB

Open AccessReview

Interventions for COVID-19 Vaccine Hesitancy: A Systematic Review and Narrative Synthesis

by Rowan Terrell, Abdallah Alami and Daniel Krewski

Int. J. Environ. Res. Public Health 2023, 20(12), 6082; https://doi.org/10.3390/ijerph20126082 - 08 Jun 2023

Cited by 3 | Viewed by 2169

Abstract

Vaccines effectively protect against COVID-19, but vaccine hesitancy and refusal hinder vaccination rates. This systematic review aimed to (1) review and describe current interventions for addressing COVID-19 vaccine hesitancy/refusal and (2) assess whether these interventions are effective for increasing vaccine uptake. The protocol was registered prospectively on PROSPERO and comprehensive search included Medline, Embase, CINAHL, PsycInfo, and Web of Science databases. Only studies that evaluated the effectiveness of non-financial interventions to address COVID-19 vaccine hesitancy were included, while those focusing intentions or financial incentive were excluded. Risk of bias for all included studies was evaluated using Cochrane risk of bias tools. In total, six articles were included in the review (total participants n = 200,720). A narrative synthesis was performed due to the absence of common quantitative metrics. Except for one randomized controlled trial, all studies reported that interventions were effective, increasing COVID-19 vaccination rates. However, non-randomized studies were subject to confounding biases. Evidence on the effectiveness of COVID-19 vaccine hesitancy interventions remains limited and further evidence is needed for the development of clear guidance on effective interventions to increase vaccine uptake. Full article

(This article belongs to the Special Issue Systematic Reviews and Meta-Analyses in Public Health)

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19 pages, 2725 KiB

Open AccessReview

Comparative Effectiveness of East Asian Traditional Medicine for Childhood Simple Obesity: A Systematic Review and Network Meta-Analysis

by Boram Lee and Chan-Young Kwon

Int. J. Environ. Res. Public Health 2022, 19(20), 12994; https://doi.org/10.3390/ijerph192012994 - 11 Oct 2022

Cited by 3 | Viewed by 2001

Abstract

Childhood obesity leads to various comorbidities and usually persists into adulthood, increasing socioeconomic burden. In the absence of a clearly effective treatment, East Asian traditional medicine (EATM) therapies have been widely used. We aimed to analyze the comparative effectiveness and safety of EATM techniques for children with simple obesity through network meta-analysis (NMA). Twelve databases were searched for randomized controlled trials (RCTs) evaluating the effect of EATMs on childhood simple obesity. Individual EATMs were ranked based on the surface under the cumulative ranking curve. The risk of bias in the individual studies and publication bias in the NMA were evaluated. Thirty-three RCTs were included. Acupuncture, chuna, chuna plus acupressure, cupping plus acupressure, herbal medicine (HM), and HM plus acupuncture significantly reduced BMI compared with lifestyle management. Based on the treatment ranking, cupping plus acupressure was optimal for BMI reduction compared with a non-medical management, followed by chuna and HM. The quality of evidence for individual findings was usually moderate to low, and no serious adverse events of EATM were reported. Cupping plus acupressure might have a large beneficial effect, and chuna or HM probably have a moderate beneficial effect on reducing BMI in children with simple obesity. Full article

(This article belongs to the Special Issue Systematic Reviews and Meta-Analyses in Public Health)

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23 pages, 1155 KiB

Open AccessReview

Small/Kiddie Cigarette Packaging Size and Its Impact on Smoking: A Systematic Review

by Halizah Mat Rifin, Miaw Yn Jane Ling, Tania Gayle Robert Lourdes, Thamil Arasu Saminathan, Wan Shakira Rodzlan Hasani, Nur Liana Ab Majid, Hamizatul Akmal Abd Hamid, Mohd Ruhaizie Riyadzi, Ahzairin Ahmad, Muhammad Fadhli Mohd Yusoff and Nor Asiah Muhamad

Int. J. Environ. Res. Public Health 2022, 19(19), 12051; https://doi.org/10.3390/ijerph191912051 - 23 Sep 2022

Cited by 1 | Viewed by 1704

Abstract

Background: Small cigarette pack sizes contain less than 20 cigarette sticks in a pack. Smaller packs may suggest lower costs, increasing affordability among lower-income users, especially the younger generation, which could lead to tobacco-related diseases and economic costs, including human capital lost results from tobacco-attributable morbidity and mortality. This concern has caused many countries to ban the sale of single cigarette sticks or kiddie packs. However, small cigarette pack sizes were proposed recently to be reintroduced by the tobacco industry with an excuse to prevent consumers from buying illicit cigarettes. This would demean efforts in combating tobacco consumption based on the existing tobacco control policies to prevent minors from purchasing cigarettes. Given the competing influences of affordability and availability of tobacco on consumption and the dearth of evidence-based review on the impact of pack size on smoking, this systematic review was conducted to identify the link between kiddie packs and smoking specifically on the initiation of smoking, urge/tendency to buy cigarettes among the general population and attempt to reduce cigarette consumption and prevalence of smoking using kiddie packs among current smokers. Methods: We include all studies except for reviews, guidelines, conference papers, commentaries, editorials, or opinion pieces. A database search was conducted in PubMed, EMBASE, CENTRAL, Web of Science and Scopus on 27 November 2021. The results were presented in the form of narrative synthesis under four groups: initiation of smoking; urge/tendency to buy cigarettes; the prevalence of smoking, and attempt to reduce cigarette consumption. The literature search identified 1601 articles, of which 21 articles had met the inclusion criteria. The methodological quality of all included articles was determined using a validated 16-item quality assessment tool (QATSDD). The average quality score for all papers was 34.8%. Discussion: Given the diverse study settings of the articles and despite the challenges of the methodological quality of some articles, this review provides some evidence that kiddie packs may increase the urge/tendency to buy cigarettes and mixed evidence on the attempt to reduce cigarette consumption. This review also found some evidence that kiddie pack purchasing among teenage smokers was higher compared to adults. However, we are uncertain about the link between kiddie packs and smoking initiation. Nevertheless, since most studies were of low quality, further high-quality studies are needed to conclude about the impact of kiddie packs on smoking to assist the policymakers and stakeholders in formulating new policies and strengthening existing strategies related to the kiddie packs. Full article

(This article belongs to the Special Issue Systematic Reviews and Meta-Analyses in Public Health)

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17 pages, 812 KiB

Open AccessReview

Recommendations on Weight Loss and Healthy Lifestyle in Prostate Cancer Clinical Guidelines: A Systematic Review

by Mario Rivera-Izquierdo, Virginia Martínez-Ruiz and José Juan Jiménez-Moleón

Int. J. Environ. Res. Public Health 2022, 19(3), 1452; https://doi.org/10.3390/ijerph19031452 - 27 Jan 2022

Cited by 3 | Viewed by 2888

Abstract

Obesity is associated with negative prostate cancer outcomes (e.g., specific mortality, all-cause mortality, biochemical recurrence, etc.), according to the current scientific literature. Nevertheless, recommendations on weight loss and healthy lifestyles are poorly covered by clinicians. We aimed at identifying these recommendations from clinical practice guidelines (CPGs) for prostate cancer. We systematically searched MEDLINE, EMBASE, Web of Science, Scopus, guideline databases and online sources for CPGs updated from January 2015 to August 2021. The searches were independently conducted by two researchers, without language restrictions. A total of 97 prostate cancer guidelines, including 84 (86.6%) CPGs and 13 (13.4%) consensus statements, were included. Recommendations on reaching and maintaining a healthy weight or healthy lifestyles were provided by 7 (7.2%) and 13 (13.4%) documents, respectively. No differences regarding recommendations were found by type of document, year of publication or country. Our results suggest that professional societies and governments should update prostate cancer guidelines to include these recommendations for improving prostate cancer prognosis. Full article

(This article belongs to the Special Issue Systematic Reviews and Meta-Analyses in Public Health)

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15 pages, 819 KiB

Open AccessSystematic Review

Smartphone Apps for Domestic Violence Prevention: A Systematic Review

by Mehreen Sumra, Sohail Asghar, Khalid S. Khan, Juan M. Fernández-Luna, Juan F. Huete and Aurora Bueno-Cavanillas

Int. J. Environ. Res. Public Health 2023, 20(7), 5246; https://doi.org/10.3390/ijerph20075246 - 23 Mar 2023

Cited by 2 | Viewed by 2390

Abstract

Smartphone applications or apps are increasingly being produced to help with protection against the risk of domestic violence. There is a need to formally evaluate their features. Objective: This study systematically reviewed app-based interventions for domestic violence prevention, which will be helpful for app developers. Methods: We overviewed all apps concerning domestic violence awareness and prevention without language restrictions, collating information about features and limitations. We conducted searches in Google, the Google Play Store, and the App Store (iOS) covering a 10-year time period (2012–2022). We collected data related to the apps from the developers’ descriptions, peer reviewed research articles, critical reviews in blogs, news articles, and other online sources. Results: The search identified 621 potentially relevant apps of which 136 were selected for review. There were five app categories: emergency assistance (n = 61, 44.9%), avoidance (n = 29, 21.3%), informative (n = 29, 21.3%), legal information (n = 10, 7.4%), and self-assessment (n = 7, 5.1%). Over half the apps (n = 97, 71%) were released in 2020–22. Around a half were from north-east America (n = 63, 46.3%). Where emergency alerts existed, they required triggering by the potential victim. There was no automation. Content analysis showed 20 apps with unique features, including geo-fences, accelerometer-based alert, shake-based alert, functionality under low resources, alert auto-cancellation, anonymous communication, and data encryption. None of the apps deployed artificial intelligence to assist the potential victims. Conclusions: Apps currently have many limitations. Future apps should focus on automation, making better use of artificial intelligence deploying multimedia (voice, video, image capture, text and sentiment analysis), speech recognition, and pitch detection to aid in live analysis of the situation and for accurately generating emergency alerts. Full article

(This article belongs to the Special Issue Systematic Reviews and Meta-Analyses in Public Health)

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15 pages, 505 KiB

Open AccessSystematic Review

The Therapeutic Impact of Plant-Based and Nutritional Supplements on Anxiety, Depressive Symptoms and Sleep Quality among Adults and Elderly: A Systematic Review of the Literature

by Darshan Kamat, Yazan A. Al-Ajlouni and Ryan C. W. Hall

Int. J. Environ. Res. Public Health 2023, 20(6), 5171; https://doi.org/10.3390/ijerph20065171 - 15 Mar 2023

Viewed by 3286

Abstract

Background: The emerging research in the literature continues to forecast a drastic and alarming increase in negative mental health and sleep health outcomes among populations, especially after the COVID-19 pandemic, which significantly influenced people’s way of life. With mental health pharmaceutical interventions continuing to be stigmatized and inaccessible among populations, natural supplements provide an opportunity for intervention. Objective: This study sought to conduct a systematic review of the literature on the most recent comprehensive evidence for which nutritional supplements have the greatest therapeutic impact on symptoms of anxiety, depression, and insomnia. Methods: A systematic search of the literature, utilizing several databases, including PubMed and Web of Science, was conducted on 29 April 2022. We used developed keywords and MeSH terms for the search. The study eligibility criteria included (1) a randomized control trial; (2) investigating a plant-based therapeutic or natural supplement as the intervention; (3) measuring at least one health outcome of the following: anxiety symptoms, depressive symptoms, or sleep health outcomes; (4) utilizing validated measurement tools to measure the outcome of interest; (5) written in the English language; (6) peer reviewed; and (7) focused on adults and elderly populations. Main Results: Following the PRISMA guidelines, 76 studies were included in this review. We used the revised Risk of Bias tool (RoB2) to assess the quality of all included randomized control trials. A qualitative data synthesis was conducted. Overall, we found several valuable insights from the evidence in the literature, including evidence that demonstrates the benefits of probiotics and vitamin B complexes on anxiety symptoms, depressive symptoms, and sleep quality. Implication of Key Findings: This review provides the most updated findings in the literature on the topic, including an abundance of research that was published in the past 5 years. Given the expected rise in negative mental and sleep health outcomes following the pandemic, the supplements and therapeutics identified in this study should be the target of intervention measures to increase their accessibility and affordability and allow them to be incorporated into clinical guidelines of treatment. PROSPERO registration number: CRD42022361130. Full article

(This article belongs to the Special Issue Systematic Reviews and Meta-Analyses in Public Health)

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11 pages, 1446 KiB

Open AccessSystematic Review

Benefits of Participation in Clinical Trials: An Umbrella Review

by Amira Bouzalmate-Hajjaj, Paloma Massó Guijarro, Khalid Saeed Khan, Aurora Bueno-Cavanillas and Naomi Cano-Ibáñez

Int. J. Environ. Res. Public Health 2022, 19(22), 15368; https://doi.org/10.3390/ijerph192215368 - 21 Nov 2022

Cited by 7 | Viewed by 1668

Abstract

Participation in randomised clinical trials (RCTs) entails taking part in the discovery of effects of health care interventions. The question of whether participants’ outcomes are different to those of non-participants remains controversial. This umbrella review was aimed at assessing whether there are health benefits of participation in RCTs, compared to non-participation. After prospective registration (PROSPERO CRD42021287812), we searched the Medline, Scopus, Web of Science and Cochrane Library databases from inception to June 2022 to identify relevant systematic reviews with or without meta-analyses. Data extraction and study quality assessment (AMSTAR-2) were performed by two independent reviewers. Of 914 records, six systematic reviews summarising 380 comparisons of RCT participants with non-participants met the inclusion criteria. In two reviews, the majority of comparisons were in favour of participation in RCTs. Of the total of comparisons, 69 (18.7%) were in favour of participation, reporting statistically significant better outcomes for patients treated within RCTs, 264 (71.7%) comparisons were not statistically significant, and 35 (9.5%) comparisons were in favour of non-participation. None of the reviews found a harmful effect of participation in RCTs. Our findings suggest that taking part in RCTs may be beneficial compared to non-participation. Full article

(This article belongs to the Special Issue Systematic Reviews and Meta-Analyses in Public Health)

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16 pages, 2501 KiB

Open AccessSystematic Review

Short and Long-Term Wellbeing of Children following SARS-CoV-2 Infection: A Systematic Review

by Juan Victor Ariel Franco, Luis Ignacio Garegnani, Gisela Viviana Oltra, Maria-Inti Metzendorf, Leonel Fabrizio Trivisonno, Nadia Sgarbossa, Denise Ducks, Katharina Heldt, Rebekka Mumm, Benjamin Barnes and Christa Scheidt-Nave

Int. J. Environ. Res. Public Health 2022, 19(21), 14392; https://doi.org/10.3390/ijerph192114392 - 03 Nov 2022

Cited by 5 | Viewed by 2720

Abstract

Post-COVID conditions in children and adolescents were mostly investigated as the incidence of individual or clusters of symptoms. We aimed to describe the findings of studies assessing key outcomes related to global wellbeing and recovery in children and adolescents from a public health perspective. We searched the Cochrane COVID-19 Study Register and WHO COVID-19 Global literature on coronavirus disease database on 5 November 2021 and tracked ongoing studies published after this date. We included observational studies on children and adolescents with a follow-up greater than 12 weeks and focused on the outcomes of quality of life, recovery/duration of symptoms, school attendance and resource use/rehabilitation. We assessed their methodological quality, and we prepared a narrative synthesis of the results. We included 21 longitudinal and 4 cross-sectional studies (6 with a control group) with over 68 thousand unvaccinated children and adolescents with mostly asymptomatic or mild disease. Study limitations included convenience sampling, a poor description of their study population and heterogeneous definitions of outcomes. Quality of life was not largely affected in adolescents following COVID-19, but there might be greater impairment in young children and in those with more severe forms of the disease (4 studies). There might also be an impairment in daily activities and increased school absenteeism following COVID-19, but the findings were heterogeneous (5 studies). A total of 22 studies provided highly variable estimates based on heterogeneous definitions of overall persistence of symptoms (recovery), ranging from 0 to 67% at 8–12 weeks and 8 to 51% at 6–12 months. We found limited data on resource use and the need for rehabilitation. One controlled study indicated that the quality of life of infected children and adolescents might not substantially differ from controls. All controlled studies found a higher burden of persistent symptoms in COVID-19 cases compared with test-negative controls or cases of influenza. There is limited evidence on the short and long-term well-being of children following SARS-CoV-2 infection. High-quality longitudinal studies with control groups are needed to describe the outcomes in this population, especially in vaccinated children and those affected by new variants of the virus. Full article

(This article belongs to the Special Issue Systematic Reviews and Meta-Analyses in Public Health)

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17 pages, 5765 KiB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis of Malaria Test Positivity Outcomes and Programme Interventions in Low Transmission Settings in Southern Africa, 2000–2021

by Olukunle O. Oyegoke, Olusegun P. Akoniyon, Ropo E. Ogunsakin, Michael O. Ogunlana, Matthew A. Adeleke, Rajendra Maharaj and Moses Okpeku

Int. J. Environ. Res. Public Health 2022, 19(11), 6776; https://doi.org/10.3390/ijerph19116776 - 01 Jun 2022

Cited by 1 | Viewed by 2271

Abstract

Malaria is one of the most significant causes of mortality and morbidity globally, especially in sub-Saharan Africa (SSA) countries. It harmfully disturbs the public’s health and the economic growth of many developing countries. Despite the massive effect of malaria transmission, the overall pooled proportion of malaria positivity rate in Southern Africa is still elusive. Therefore, the objective of this systematic review and meta-analysis is to pool estimates of the incidence of the malaria positivity rate, which is the first of its kind in South African countries. A literature search is performed to identify all published articles reporting the incidence of malaria positivity in Southern Africa. Out of the 3359 articles identified, 17 studies meet the inclusion for systematic review and meta-analysis. In addition, because substantial heterogeneity is expected due to the studies being extracted from the universal population, random-effects meta-analyses are carried out to pool the incidence of the malaria positivity rate from diverse diagnostic methods. The result reveals that between-study variability is high (τ² = 0.003; heterogeneity I² = 99.91% with heterogeneity chi-square χ² = 18,143.95, degree of freedom = 16 and a p-value < 0.0001) with the overall random pooled incidence of 10% (95%CI: 8–13%, I² = 99.91%) in the malaria positivity rate. According to the diagnostic method called pooled incidence estimate, the rapid diagnostic test (RDT) is the leading diagnostic method (17%, 95%CI: 11–24%, I² = 99.95%), followed by RDT and qPCR and RDT and loop mediated isothermal amplification (LAMP), respectively, found to be (3%, 95%CI: 2–3%, I² = 0%) and (2%, 95%CI: 1–3%, I² = 97.94%).Findings of the present study suggest high malaria positive incidence in the region. This implies that malaria control and elimination programmes towards malaria elimination could be negatively impacted and cause delays in actualising malaria elimination set dates. Further studies consisting of larger samples and continuous evaluation of malaria control programmes are recommended. Full article

(This article belongs to the Special Issue Systematic Reviews and Meta-Analyses in Public Health)

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12 pages, 2381 KiB

Open AccessSystematic Review

Trends of Water, Sanitation, and Hygiene (WASH) Research in Indonesia: A Systematic Review

by S. Satriani, Izana Saffana Ilma and D. Daniel

Int. J. Environ. Res. Public Health 2022, 19(3), 1617; https://doi.org/10.3390/ijerph19031617 - 30 Jan 2022

Cited by 5 | Viewed by 6460

Abstract

This study provides an overview of water, sanitation, and hygiene (WASH) research trends in Indonesia from 1975 until April 2021. The systematic review compiled 272 articles related to the Sustainable Development Goals 6.1 and 6.2 in Indonesia, which were published in the Web of Science and Scopus databases. The results showed that the water-related topic (41%) was discussed more often than sanitation (22%) or hygiene (13%). Furthermore, the social theme (39%) was dominantly found in all these articles, mostly finding determinants of WASH-related behavior. However, few WASH implementation studies or behavioral change interventions were recorded in Indonesia, suggesting a gap between science and policy or implementation. On the other hand, hygiene-related topics (14%) and WASH-related financial themes (6%) were the least studied in Indonesia. Combinations of topics (23%) and themes (15%) were also often conducted in Indonesia, suggesting that WASH researchers started to recognize the need to analyze WASH problems holistically, i.e., from multiple perspectives. In addition, the distribution of WASH research was still dominated in the central part of Indonesia, whereas the WASH-related problems, i.e., poor WASH services, and behavior, often occur in this area. This study also offers some research gaps, both in terms of topics, themes, and regional distribution, that need to be considered for the design of future WASH research in Indonesia. Full article

(This article belongs to the Special Issue Systematic Reviews and Meta-Analyses in Public Health)

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