The introduction to the systematic literature Methodology
A systematic review uses scientific methodologies in identifying, analyzing, and evaluating evidence that has already been presented of an existing problem to ensure that it produces an unbiased conclusion. This is an effective method of carrying out research as it is more linked with providing comprehensive, precise, and evidence-based research (Glasziou & Colditz, 2001) With the high number of research that is being posted on the different websites, there is the need to evaluate the resource and classify them in relation to sources that are more relevant and those with desired outcomes too. Hence they aim to make more informed decisions in relation to preterm births in pregnant women with the cause of anemia.
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Hence by doing a systematic review, a more advanced report will be developed. This will also be impactful for anyone looking for data online. This will also be impactful as it will address all the gaps that have been left by the existing literature hence improving the quality of data available. In a study done by (Glasziou & Colditz, 2001), he concludes that systematic review is strict on the selected questions, provides precise eligibility questions, a more reputable approach, and offers an extensive search of the resources (McCauley & van den Broek, 2022). Generally, conducting a comprehensive systematic review helps the researchers advance the existing data and also advance the available in-depth data. However, it is subjected to various limitations, such as can be time-consuming, and with lack of awareness, there are higher chances that this could take longer time than thought it could.
Search Strategy
In previous research, a systematic review has to be carried out by more than two researchers to ensure that there is less bias. However, this research was considered by a student underrating a master’s degree in Public health. To ensure that there is a high level of transparency, the researchers used a PRISMA flow chart and also employed the Cochrane handbook written for the systemic review of interventions. When carrying out research, it is important to use a wide variety of sources to collect relevant data. This is considered that there are many websites that offer information regarding the health of people. For instance, considering that EMBASE, CINAHL MEDLINE Pubmed, and Sci direct are an example of databases within healthcare, PsycINFO and ASSIA are among databases that offer such but within social science. With a search strategy, it is easy to identify such. Through the literature, we only considered data that are from peer-reviewed journals from websites such as Pubmed, direct science, Medline, and EMbase to ensure that the outcomes that have been reported are clinically based.
Search bibliographic Databases
Online sources are easy to find as they are usually updated to meet the current changes. This makes it easy for one to locate them. Hence with online sources, the researcher considered doing searches for the relevant articles. Databases considered were EMBASE, CINAHL MEDLINE Pub med, and Science Direct. Through this study, the researcher considered only articles that have been published not older than five years, which considered a review comparison with mothers who are pregnant with anemia and those who are pregnant without anemia. During this search, only English works were considered. However, this was considered that during translation, the translator could miss some words or even understand the author wrongly, which can, in turn, lead to altering of the meaning. This is one of the bases as to why the research only considered articles that have been written originally in English and not in other languages. However, this raised some bias as some research (Neimann Rasmussen & Montgomery, 2018) claimed that excluding sources that are not in English can result in language bias. However (Delgado-Rodríguez & Sillero-Arenas, 2018) claims that there is no noticeable language bias to be identified when carrying out a meta-analysis outcome. To ensure that an extensive search has been attained, the author considered using relevant keyword searches and also considered paying visits to the library to find any sources that could help have adequate data.
Search key terms and Search Strategy
In a study carried out by Boland et al. 2017, after identifying the bibliographical resources, keywords were developed to ensure that a search strategy for every database had been developed. Through the search strategies, various parts of research questions were developed to ensure that a broad search has been attained. With the Cochrane review, strategy research design population and intervention questions are to be addressed. This then promoted the use of the PICO tool to help in identifying and searching the terms. However, synonyms of keywords such as anemia, pregnancy, and preterm births were used for extensive results. In a research done by (Bramer & Kleijnen, 2018), he reports that keywords and medical subheadings are of high importance in developing a search strategy. Furthermore, there was no limitation on the number of materials to be explored. However, in truncating documents, the researcher used an asterisk (*) alongside an operator, which could be AND, OR, NOT, to ensure that even though a wide search is aimed at, it is all linked to the relevance. To ensure that ether was no bias when making the choices, all the searches were conducted after a tutorial with the expert librarian. This then followed an immediate screening that considered the title and the Abstract check removal of duplicates. The remaining articles were then reviewed in full to determine the scoping review and synthesis of the findings that met all the criteria required.
Review questions for the systematic review
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This review has been created to locate, analyze and synthesize available data while trying to address the causes of anemia in prenatal women that result in preterm births. Furthermore, this review will analyze possible interventions, especially offering communal education to mothers on the foods that can help them fight iron deficiency.
There are different frameworks that can be used while structuring systematic review questions. In this research, we will consider the PICO framework, which is a common framework applied when dealing with quantitative analysis. PICO has proved to be an effective framework for analyzing interventions. In analyzing the PICO, the major components to be considered are (Lasserson & Higgins, 2019) (Population intervention counter intervention, and Outcomes). With this, it is also easy to locate useful sources. Furthermore, this also plays an important role in helping determent the research questions of the study. 
Selection of studies
To ensure that a more clear focus on the issues at hand and works to be used have been chosen appropriately, there is the need for precision. This then calls for inclusion and exclusion criteria. Furthermore, having an inclusion and exclusion criteria is one of the requirements for a systematic review that brings the difference from narrative reviews (Siddaway & Hedges, 2019). Hence the research used the PICO framework to determine the criteria for including and excluding resources.
Type of participants (p)
Expectations mothers from the age of 20-40 were considered to be major participants of the study. This study considered this age group as it all included mothers who just became mothers and they have not established their lives, and also an age gap of a mother who became pregnant and still has established their lives. However, studies that involved minors who were pregnant and had anemia was included as they did not meet the inclusion criteria.
Types of Interventions (I)
Many studies have studied on ensuring that each pregnant mother has a clinical book that contains adequate education (Hosseini Tabaghdehi & Motaghi, 2020). Other studies have also called for the government to come in with more funds to support the poor families by providing supplements or even making food donations that will help them (Siddaway & Hedges, 2019). Furthermore, this research will consider offering communal education on how to balance the available food to ensure that the iron deficiency has been tackled.
Types of Counter Interventions (C)
Blood transfusions
Types of Outcomes (O)
The outcomes of anemia in pregnancy that leads to preterm births were preterm births, breathing disorders, chest pains, delayed millstones or stillbirths, antenatal visits, number of haemogram tests, and experience of anemia in pregnancies. However, there was also a difference in social-economical factors such as income, level of education, and the occupation of spouses.
Types of Studies in writing help
In an evaluation of the different qualities of the findings, there are various ranking systems that can be used. The hierarchy of evidence has affirmed that the RCT is one among the topmost when placed in the evidence pyramid. It is then followed by the observational studies, and then the uncontrolled studies are at the bottom of the pyramid. Further, randomization will be used in the studies to reduce the bias and also equalize the confounding factors within the groups. Furthermore, only studies that are related to the major keywords will be considered for the general study.
Data Collection
An excel sheet was used to portray the relevant data collected considering met analysis data, baseline carters of the population used, a summary of the studies that were used, and data for the narrative synthesis. Through the study, it included The data to be extracted will include information about the sources, design of the study, geographical location, the aim of the study, the population used, and the conclusions made of the study. Within the baseline characteristics, the study will consider information such as the study ID and the race, which will include all the races such as Black, white, and others, gender, and rural-urban classification. In the third section, which is the statistical data of the meat analysis, the research will consider the mean and standard deviation statically attained from the designated groups separately. In the fourth section, data for the narrative synthesis will include data collected for the study, ID the outcomes, the results, and measures results. Through the data, different tables will be created for the different sectional data.
Religion Languages and date of publishing
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This study was not limited to a certain geographical; hence it reviewed literature from a global perspective. However, only articles that had been written in English as the research was limited to translating articles considering the chances of errors while transcribing. This also included that any work that was originally written in another language but later translated was not included too. The study considered articles with a publication age of not more than five years. This was to ensure that all the studies used were dated.
Quality Assessment
It was important to ensure that the studies that have been chosen have also been assessed to measure the quality of the studies being used. This is a step that was done during data extraction. This was to ensure that the researcher was able to respond to any quality assessment questions. Furthermore, this could also play a big role in helping avoid selection bias in such collecting data, not minding if they support or they contradict the hypothesis. Following this procedure, it plays an essential role in removing the poor-quality works that could affect the findings of the researcher. Furthermore, it also saves time as it excludes the extraction of data that is not required. Through quality assessment, it was easy for the researcher to identify reliable research that was designed, and after evaluation, the researcher was able to conclude if the research was relevant to answering the main question or not. Through quality assessment, the researcher got the different perfections and the different methodologies and the outcome that the different resources had posted that helped the researcher to know the value and how to rate sources as poor quality and which one to be considered of high quality.
In the systematic review, there are various tools that could be put in use to measure the quality of the sources. However, it also depends on the type of question to be addressed. In many instances, Scales have been used, while others consider the use of a checklist as they are more comprehensive and can also be studied by other people to measure the quality too. Critical appraisal skill program and new castle Ottawa scales are among the majorly used scales. Considering that many of the studies were observational, the National Institute of health quality assessment tool was considered to be the most appropriate tool. This tool focused on studying a source with different questions, such as judging the clarity of the questions used in the study. What kind of population has the study used, the participation numbers, and the inclusion/ the exclusion criteria that have been used in the said sources. The justification of sample size, time frame, the follow-up procedures definition validly, the rate of exposures, the measure of outcomes, and the sufficient level of the outcomes were used. Through the analysis, the researcher considered giving answers with no, yes, applicable, and not applicable depending on the findings that the researchers will find after studying eth sources with the above questions. With the procedure, which took a lot of time but yielded good results, the research had the capability of utilizing only resources that were qualified. 
Characteristics of included studies
Study   ID
Study   Design
Population   age
Study   Aim
Moreno-Fernandez, & Diaz-Castro, 2019
Systematic Review

m 24 to 36 weeks
Determine the Effects   of iron status on preterm infants’ growth and development parameters
Most of the time,   premature newborns need iron supplements and are prone to ID or IDA   development, which may influence postnatal behavior and cognitive   development.
Kang & Sunwoo, 2020
A systematic review and   meta-analysis
22.6 to 34.8
Utilizing a meta-analysis   to determine the association between anemia and the risk of maternal   depression.
Anemia was linked to a   higher incidence of maternal depression in both the antepartum and postpartum   periods, according to a recent meta-analysis of observational epidemiological   studies.
Safiri & Grieger, 2021
The current study   details the burden of anemia on a global, regional, and national scale, as   well as its underlying causes.
Despite the   multifaceted character of the condition, dietary iron deficiency is still the   biggest contributor to anemia worldwide. Therefore, nutritional interventions   must get more focus, followed by efforts to reduce the burden of chronic   diseases, parasite infections, and hemoglobinopathies.
Walang, 2020
Southeast Asia and sub-Saharan Africa.
Analyze the major   causes of Preterm births among women in developing countries
The global preterm   birth rate of 11% is a result of anemia cases experienced by women before and   during pregnancies.
Maier & Zeitlin, 2018
cohort studies
European Regions
22 + 0 and 31 + 6 weeks
To compare the length   of hospital stays for infants who were born very preterm and extremely   preterm in 10 different European locations and track changes over time.
Policies to optimize   discharge decisions in terms of baby outcomes and health system expenditures   should be informed by a better knowledge of the discharge criteria and care   practices that cause the significant variations in the very preterm length of   stay across European areas.
Sample & Platini, 2019
Quantitative design
This study attempts to   ascertain pregnant anemic women’s understanding of pregnancy nutrition.
Based on the findings   of a study on the nutritional intake knowledge of pregnant women with Anemia   at Puskesmas (Community Health Center) Sukamulya Garut, it can be said that   nearly all of them lacked such knowledge.
Aston & Paynter, 2021
This study looked at   how first-time moms used online and offline resources to get help during the   first six months after giving birth and how social and institutional   discourses shaped their experiences.
These online discussion   boards provide useful information for medical practitioners trying to enhance   postpartum care for moms and highlight the necessity of creating places where   new mothers can interact.
Graham, 2018
Indonesia, 2020
Central Sulawesi
The goal of this study   is to determine how the smart book on pregnancy-postpartum care affects   husbands’ knowledge and the incidence of difficulties with reproductive   health.
The postpartum care   book educated men about pregnancy, labor, and postpartum issues.
Baig-Ansari & Goldenberg, 2008
To assess the   prevalence of anemia in pregnant women residing in an urban population in   Hyderabad, Pakistan, as well as the dietary and socioeconomic factors related   to anemia.
At 20 to 26 weeks of   pregnancy, a significant portion of women experienced mild to moderate   anemia. Anemia was linked to a pica, drinking tea, and eating a few eggs and   red meat. Prior to getting pregnant, in particular, women of reproductive age   should receive nutritional education about food sources of iron and how food   choices can either improve or interfere with iron absorption.
Rahman & Shibuya, 2016
systematic review and   meta-analysis
South Asia sub-Saharan   Africa
systematic review and   meta-analysis to calculate the population-attributable percentage (PAF) of   these outcomes that are caused by anemia in low- and middle-income countries,   the pooled prevalence of anemia, the relationship between maternal anemia and   pregnancy outcomes, 
Maternal anemia   continues to be a serious health issue in low- and middle-income nations.
In low-income nations   and the South Asian region, the percentage of unfavorable pregnancy outcomes   attributed to anemia was greater.
Youssry & Patel, 2018
cohort study

Our study’s objectives   are to determine the prevalence of anemia in pregnant women and the impact of   anemia severity on maternal and perinatal outcomes.
His research made it   clear that anemia, especially mild anemia, is common among expectant mothers.   Maternal anemia must be managed, and the perinatal outcome is strongly   impacted by early diagnosis and therapy beginning in the first trimester. The   most frequent maternal and neonatal problems are prematurity, low birth   weight babies, and postpartum hemorrhage.
Ballestín & Bartolomé, 2021).

In this review, the   research on how nutritional deficits affect maternal and infant morbidity   will be summarized.
Micronutrient   deficiencies have a negative impact on pregnant women’s health and the   pregnancy’s outcome. Since there are multiple inadequacies, repairing or   supplementing one won’t have much of an impact while there are still others   that need to be addressed.

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