Quality appraisal of each included study.
| References | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | Q9 | Q10 | Q11 | Q12 | Q13 | Q14 | Q15 | Q16 | Q17 | Q18 | Q19 | Q20 | Yes | No | Yes (%) | Risk of biais |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ajibade et al., 2013 [31] | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | No | No | Yes | 15 | 4 | 84% | Low |
| Alalagy et al., 2025 [32] | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 15 | 4 | 84% | Low |
| Brien et al., 2018 [33] | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 15 | 4 | 84% | Low |
| El Ata et al., 2016 [14] | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | No | No | Yes | 15 | 4 | 84% | Low |
| Elghazally et al., 2023 [21] | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | No | No | Yes | 15 | 4 | 84% | Low |
| Freimann et al., 2016 [34] | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 15 | 4 | 84% | Low |
| Kgakge et al., 2019 [15] | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 15 | 4 | 84% | Low |
| Mailutha et al., 2020 [35] | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | No | No | Yes | 14 | 5 | 79% | Medium |
| Moodley et al., 2020 [16] | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 16 | 3 | 89% | Low |
| Munabi et al., 2014 [36] | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 16 | 3 | 89% | Low |
| Mutanda et al., 2017 [37] | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 16 | 3 | 89% | Low |
| Muthelo et al., 2023 [38] | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 15 | 4 | 84% | Low |
| Nemera et al., 2024 [39] | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | No | No | Yes | 15 | 4 | 84% | Low |
| Nkhata et al., 2015 [40] | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 15 | 4 | 84% | Low |
| Ojedoyin et al., 2025 [20] | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | No | No | Yes | 15 | 4 | 84% | Low |
| Ouni et al., 2020 [41] | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 15 | 4 | 84% | Low |
| Sorour et al., 2012 [19] | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 15 | 4 | 84% | Low |
| Tinubu et al., 2010 [42] | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 15 | 4 | 84% | Low |
| Yitayeh et al., 2015 [43] | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | No | NA | Yes | Yes | Yes | Yes | No | Yes | 16 | 3 | 89% | Low |
Q1: Were the aims/objectives of the study clear?
Q2: Was the study design appropriate for the stated aim(s)?
Q3: Was the sample size justified?
Q4: Was the target/reference population clearly defined? (Is it clear who the research was about?)
Q5: Was the sample frame taken from an appropriate population base so that it closely represented the target/reference population under investigation?
Q6: Was the selection process likely to select subjects/participants that were representative of the target/reference population under investigation?
Q7: Were measures undertaken to address and categories non-responders?
Q8: Were the risk factor and outcome variables measured appropriate to the aims of the study?
Q9: Were the risk factor and outcome variables measured correctly using instruments/measurements that had been trialed, piloted or published previously?
Q10: Is it clear what was used to determined statistical significance and/or precision estimates? (eg, p values, CIs)
Q11: Were the methods (including statistical methods) sufficiently described to enable them to be repeated?
Q12: Were the basic data adequately described?
Q13: Does the response rate raise concerns about non-response bias?
Q14: If appropriate, was information about non-responders described?
Q15: Were the results internally consistent?
Q16: Were the results for the analyses described in the methods, presented?
Q17: Were the authors discussions and conclusions justified by the results?
Q18: Were the limitations of the study discussed?
Q19: Were there any funding sources or conflicts of interest that may affect the authors ‘interpretation of the results?
Q20: Was ethical approval or consent of participants attained?
Column 19 was treated as ‘Yes’ in the risk of bias calculation (the absence of conflict for interpretation is a guarantee of quality).