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Table 5 Quality Assessment of Articles Selected – Demographics Results

From: Epidemiology and demographics of juvenile idiopathic arthritis in Africa and Middle East

Sr. No. Reference Country Study Design N (no. of cases) Classification Criteria Time Period Limitations
Regional
1 Consolaro et al., 2019 [22] Africa and Middle East Retrospective chart review with prospective cross-sectional questionnaire 1209 ILAR 2011-2016 •There was disproportionate number of patients included from various geographical areas
•Potential underrepresentation of milder forms of JIA and referral bias
•Wide variation in tests and evaluation can affect evaluations or tests
•Some countries could not be included
•Method of grouping some countries in a particular geographical area was arbitrary
•Wide variation in healthcare resources across countries
2 Al-Mayouf et al., 2021 [28] Arab (Saudi Arabia, Libya, United Arab Emirates, Jordan, Oman, Egypt, Kuwait) Retrospective chart review with prospective disease activity and disease assessment 702 ILAR 2010-2019 •It was a cross-sectional analysis
•There is a possibility of patients
•selection bias as the participating centers did not enroll the same number of patients
•Wide variation in healthcare resources across countries
Country
3 Khuffash et al., 1988 [13] Kuwait Hospital, consultations 41 ARA 1978-1987 •10-year study period
•ACR criteria utilized
•Potential referral bias of more severe cases specifically systemic JIA
4 Khuffash et al., 1990 [14] Kuwait Hospital, medical records revised by experts, hospital attendance 108 ARA 1981-1988 •Retrospective
•Large population cohort
•Possible underestimation of undiagnosed cases in the community and nonreferral by primary care practitioners
•Children aged between 12 and 16 years were excluded.
•Female children possibly underrepresented
•No current data is available
5 Abdwani et al., 2015 [11] Oman Retrospective, Hospital, medical records, multicentre 107 ILAR 2004-2013 •Retrospective
•10-year study duration
•Potential underestimation, only children <13 years of age were included
•Potential referral bias, study might have missed on milder cases
6 Ozen et al., 1998 [15] Turkey Community based survey (parent questionnaire, clinical exam in homes) 30 EULAR 1997 •Community-based study from 5 districts in turkey
•Possible Exclusion of undiagnosed cases not identifiable from questionnaires may have led to possible underestimation
7 Abou El-Soud et al., 2013 [12] Egypt Population based in Sharkia Governate prospective study, with retrospective chart review 132 ILAR 2009-2010 •First population-based study from Sharkia governate
•Large population cohort included 19 districts
•Possible underestimation of numbers due to undiagnosed cases in the community and nonreferral from primary care practitioners
8 Furia et al., 2020 [47] Tanzania Retrospective hospital chart review 28 EULAR 2012-2019 •Single centered study
•Retrospective study
•Possible referral bias and underestimation of milder forms of disease
9 Aiche et al., 2018 [31] Algeria Cross sectional survey parent/PRO 70 ILAR 2012-2013 •The objective of the study was to cross-culturally adapt and validate child/adult version of the Juvenile Arthritis Multidimensional Assessment
Report (JAMAR) in JIA patients
•Possible selection bias
•Only selected centers were invited to participate
10 Al Marri et al., 2017 [32] Saudi Arabia Prospective record review 23 ILAR 1990-2015 •Potential referral bias could have caused the overall frequency of familial JIA and recurrence risk
•Heterogeneous patients were included and were not compared with controls
11 Al-Mayouf et al., 2018 [35] Saudi Arabia Cross sectional survey parent/PRO 100 ILAR 2012-2016 •The objective of the study was to cross-culturally adapt and validate child/adult version of the Juvenile Arthritis Multidimensional Assessment
Report (JAMAR) in JIA patients
Possible selection bias
•Only selected centers were invited to participate
12 Salah et al., 2009 [63] Egypt Retrospective hospital chart review 196 ILAR 1990-2006 •Single center tertiary hospital study
•Higher frequency of oligoarticular JRA, polyarticular and systemic onset JRA could be due to referral bias to tertiary care facilities
13 Al-Abrawi et al., 2018 [33] Oman Cross sectional survey parent/PRO 57 ILAR 2012-2013 •The objective of the study was to cross-culturally adapt and validate child/adult version of the Juvenile Arthritis Multidimensional Assessment
Report (JAMAR) in JIA patients
•Possible selection bias
•Only selected centers were invited to participate
14 Demirkaya et al., 2018 [45] Turkey Cross sectional survey parent/PRO 466 ILAR 2012-2014 •The objective of the study was to cross-culturally adapt and validate child/adult version of the Juvenile Arthritis Multidimensional Assessment
Report (JAMAR) in JIA patients
•Possible selection bias
•Only selected centers were invited to participate
15 El Miedany et al., 2018 [46] Egypt Cross sectional survey parent/PRO 100 ILAR 2014-2015 •The objective of the study was to cross-culturally adapt and validate child/adult version of the Juvenile Arthritis Multidimensional Assessment
Report (JAMAR) in JIA patients
•Possible selection bias
•Only selected centers were invited to participate
16 Hashad et al., 2018 [48] Libya Cross sectional survey parent/PRO 100 ILAR 2014-2015 •The objective of the study was to cross-culturally adapt and validate child/adult version of the Juvenile Arthritis Multidimensional Assessment
Report (JAMAR) in JIA patients
•Possible selection bias
•Only selected centers were invited to participate
17 Oyoo et al., 2016 [55] Kenya Retrospective hospital chart review 68 ILAR 2009-2016 •Single center tertiary hospital study
•Center covers patients from all over Kenya, greater East and Central African region
•RF positive polyarthritis patients may be overrepresented which were classified using only one positive assay
•Possible underrepresentation of RF negative polyarthritis
•Potential referral bias of severe forms of the disease
18 Scott et al., 2018 [57] South Africa Cross sectional survey parent/PRO 91 ILAR 2013-2016 •The objective of the study was to cross-culturally adapt and validate child/adult version of the Juvenile Arthritis Multidimensional Assessment
Report (JAMAR) in JIA patients
•Possible selection bias
•Only selected centers were invited to participate
19 Sen et al., 2015 [58] Turkey Retrospective hospital chart review 213 ILAR 1998-2013 •Single center study
•The collected data may be incomplete and incorrect due to the retrospective study design
•HLA-B27 test was not done for all patients
20 Shafaie et al., 2018 [59] Iran Cross sectional survey parent/PRO 102 ILAR 2012 •The objective of the study was to cross-culturally adapt and validate child/adult version of the Juvenile Arthritis Multidimensional Assessment
Report (JAMAR) in JIA patients
•Possible selection bias
•Only selected centers were invited to participate
21 Yener et al., 2020 [61] Turkey Retrospective hospital chart review 116 ILAR 2012-2018 •Single center study
•Retrospective cohort study
•The study included lower number of patients as compared to other studies conducted in the country
22 Çakan et al., 2017 [41] Turkey Retrospective hospital chart review 265 ILAR 2010-2016 •Single center study
•The study included lower number of patients
•Short follow-up time
23 Kasapçopur et al., 2004 [51] Turkey Retrospective hospital chart review 198 ILAR NA •Single center study
•Study conducted to determine frequency of ANA positivity and uveitis in newly diagnosed JIA patients
24 Ozdogan et al., 1991 [56] Turkey Retrospective hospital chart review 147 EULAR/WHO 1980-1988 •Single center study
•Potential referral bias of milder forms of comorbidities such as uveitis
25 Abdul-Sattar et al., 2014 [30] Egypt Cross sectional Medical chart review, school attendance records, HRQOL questionnaire 52 ILAR 2011-2013 •Single center study
•Included patients aged 7-17 years diagnosed to ILAR criteria
•Study aimed to investigate JIA patients school absenteeism and school functioning
•Potential selection and referral bias
•Cross-sectional study design limits the ability to determine temporal relationships between risk factors and both of school absenteeism and of poor school functioning
26 Abdul-Sattar et al., 2014 [29] Egypt Medical chart review, Health related quality of life (HRQoL) questionnaire 58 ILAR 2010-2012 •Single center study
•Included patients aged 8-18 years diagnosed to ILAR criteria
•Small study sample
•Study aimed to identify determinants of impaired HRQOL in children with JIA
•Cross-sectional design limits the ability to determine temporal relationships between risk factors and HRQOL
27 Albokhari et al., 2019 [36] Saudi Arabia cross sectional health related quality of life survey 44 ILAR 2017 •Single center study
•Study aimed to evaluate effect of JIA on HRQOL
•Single center study
•Potential referral bias and over representation of more severe forms
28 Al-Hemairi et al., 2015 [34] Saudi Arabia Retrospective hospital chart review 82 ILAR 2007-2015 •Retrospective record-based study
•Single centered
•Small sample size
•Diagnosis was confirmed by pediatric rheumatologist
29 Amine et al., 2009 [38] Morocco Health related quality of life (HRQoL) survey 80 ILAR 2006-2007 •The aim of the study was to assess HRQoL- related impact of JIA
•Demographics, subtype, clinical and lab parameters were obtained for patients
•Potential selection and referral bias over-representation of severe forms
30 Bahabari et al., 1997 [39] Saudi Arabia Retrospective hospital chart review with prospective follow-up 115 ACR 1978-1993 •Multi-center study
•18 months follow up
•Potential referral bias and under representation of milder forms
31 Bouaddi et al., 2013 [40] Morocco Cross-sectional prospective 33 ILAR 2013 •Aim of the study was to assess the impact of JIA on schooling
•Single center
•Case control
•Small sample size
32 Chipeta et al., 2013 [42] Zambia Retrospective hospital chart review 78 EULAR/ILAR 1994-1998 and 2006-2010 •Single center
•Potential referral bias
•Two different classifications were used for each study period
•1994-1998 EULAR
•2006-2010 ILAR
•ANA test was not routinely available
33 Hussein et al., 2018 [49] Egypt Retrospective hospital chart review with prospective follow-up 63 ILAR 2004-2010 •Single center
•Cross sectional design
34 Olaosebikan et al., 2017 [54] Nigeria Retrospective hospital chart review 28 not specified 2010-2016 •Single center
•Patients referred to adults rheumatologists due to lack of pediatric rheumatology service
•The study included all types of pediatric rheumatology patients, hence unreliable representation of JIA demographics
35 Weakley et al., 2012 [60] South Africa Prospective cross sectional 78 ILAR 2010-2011 •Small sample size
•Sample bias
•Mutli-center
36 Mostafa et al., 2019 [53] Egypt Cross sectional HRQol and functional disability questionnaire 48 ILAR 2018 •Aim of the study was to assess functional disability in JIA patients
•Single-centered
•Potential referral bias and underrepresentation of milder forms
37 Dagher et al., 2014 [43] Lebanon Retrospective chart review 66 ILAR 2010-2014 •Single center
•Potential referral bias
38 Khawaja et al., 2017 [52] UAE Retrospective hospital chart review ICD codes 66 ILAR 2011-2014 •Aim of the study was to assess access to care for JIA patients amongst local and non-local population
•Potential referral bias
•Selection bias
39 Alzyoud et al., 2020 [37] Jordan Retrospective hospital chart review 210 ILAR 2015-2019 •Single center
•Potential referral bias
•Patients above 14 years of age were not included
40 Demirkaya et al., 2011 [44] Turkey Retrospective cross sectional from registry 634 ILAR 2008-2009 •Multi-center
•Registry is not representative of all centers from Turkey
41 Karadag et al., 2020 [50] Turkey Retrospective hospital chart review with prospective data collection 281 ILAR 2018-2019 •Retrospective chart review
•1-year study duration, some patients did not have final diagnosis confirmed
•Single center
•Potential referral bias
42 Yilmaz et al., 2008 [62] Turkey Retrospective chart review 196 ILAR 1995-2004 •Hospital based
•Single center
•Referral bias may explain low prevalence of oligoarticular JIA and low uveitis