1
|
Ortiz-Toquero S, Sanchez I, Serrano A, Martin R. Prevalence of Computer Vision Syndrome and Its Risk Factors in a Spanish University Population. Eye Contact Lens 2024:00140068-990000000-00208. [PMID: 38865594 DOI: 10.1097/icl.0000000000001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES To determine the prevalence of digital eye strain or computer vision syndrome (CVS) and its risk factors in a university population (University of Valladolid, Spain). METHODS An anonymous cross-sectional online survey was conducted in a university population [staff (lecturers and administrative employees) and students (undergraduate, master's, and PhD)], including two validated questionnaires (Ocular Surface Disease Index [OSDI] and the 17-item Computer-Vision Symptom Scale questionnaire [CVSS17]) and questions about sociodemographic data and visual display terminal use. The prevalence and risk factors for CVS (CVSS17≥29) (multivariate logistic regression model) were calculated. RESULTS One thousand nine participants responded to the survey (35.2±15.2 years; 64.1% women). The mean OSDI and CVSS17 questionnaire scores were 18.9±15.6 and 31.5±6.4, respectively, and 35.4% of the respondents had dry eye symptoms (OSDI>22). The total prevalence of CVS was 65.4% (95% CI 62.1-68.3). Undergraduate students showed the highest CVS prevalence (72.6%; P <0.01), which was significant. In addition, women, participants younger than 36 years old, contact lens wearers, and subjects with dry eye symptoms reported a statistically higher CVSS17 score ( P ≤0.01). In the multivariate model, significant factors associated with the presence of CVS ( P ≤0.03) were female sex (OR=2.10; 95% CI 1.54-2.88), dry eye symptoms (OSDI>22) (OR=16.98; 95% CI 10.36-27.84), VTD use ≥6 hr daily (OR=1.96; 95% CI 1.09-3.52), and being an undergraduate student (OR=2.23; 95% CI 1.54-3.24). CONCLUSION A high prevalence (65.4%) of CVS was found among the Spanish university population, with the undergraduate student group having the highest prevalence (72.6%). Female sex, more than 6 hr/day of visual display terminal use, being an undergraduate student, and dry eye symptoms significantly increased the risk of CVS in the university population.
Collapse
Affiliation(s)
- Sara Ortiz-Toquero
- Instituto Universitario de Oftalmobiología Aplicada (IOBA) (S.O.-T., I.S., A.S., R.M.), Universidad de Valladolid, Valladolid, España; Departamento de Física Teórica (S.O.-T., I.S., A.S., R.M.), Atómica y Óptica, Universidad de Valladolid, Valladolid, España; and Optometry Research Group (S.O.-T., I.S., A.S., R.M.), IOBA Eye Institute, School of Optometry, University of Valladolid, Valladolid, Spain
| | | | | | | |
Collapse
|
2
|
León-Figueroa DA, Barboza JJ, Siddiq A, Sah R, Valladares-Garrido MJ, Adhikari S, Aguirre-Milachay E, Sah S, Rodriguez-Morales AJ. Prevalence of computer vision syndrome during the COVID-19 pandemic: a systematic review and meta-analysis. BMC Public Health 2024; 24:640. [PMID: 38424562 PMCID: PMC10902934 DOI: 10.1186/s12889-024-17636-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/01/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Computer vision syndrome has become a significant public health problem, especially in developing countries. Therefore, this study aims to identify the prevalence of computer vision syndrome during the COVID-19 pandemic. METHODS A systematic review and meta-analysis of the literature was conducted using the databases PubMed, Scopus, Web of Science, and Embase up to February 22, 2023, using the search terms "Computer Vision Syndrome" and "COVID-19". Three authors independently performed study selection, quality assessment, and data extraction, and the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used to evaluate study quality. Heterogeneity was assessed using the statistical test I2, and the R version 4.2.3 program was used for statistical analysis. RESULTS A total of 192 studies were retrieved, of which 18 were included in the final meta-analysis. The total sample included 10,337 participants from 12 countries. The combined prevalence of computer vision syndrome was 74% (95% CI: 66, 81). Subgroup analysis based on country revealed a higher prevalence of computer vision syndrome in Pakistan (99%, 95% CI: 97, 100) and a lower prevalence in Turkey (48%, 95% CI: 44, 52). In addition, subgroup analysis based on study subjects showed a prevalence of 82% (95% CI: 74, 89) for computer vision syndrome in non-students and 70% (95% CI: 60, 80) among students. CONCLUSION According to the study, 74% of the participants experienced computer vision syndrome during the COVID-19 pandemic. Given this finding, it is essential to implement preventive and therapeutic measures to reduce the risk of developing computer vision syndrome and improve the quality of life of those affected. TRIAL REGISTRATION The protocol for this systematic review and meta-analysis was registered in the international registry of systematic reviews, the International Prospective Register of Systematic Reviews (PROSPERO), with registration number CRD42022345965.
Collapse
Affiliation(s)
- Darwin A León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, 15011, Peru
- Centro de Investigación en Atención Primaria en Salud, Universidad Peruana Cayetano Heredia, Lima, 15102, Peru
| | - Joshuan J Barboza
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Universidad San Ignacio de Loyola, Juan del Corral 937. El Bosque, Trujillo, Lima, Peru
| | | | - Ranjit Sah
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, 44600, Nepal
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, India
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune, 411018, Maharashtra, India
| | - Mario J Valladares-Garrido
- Universidad Continental, Lima, 15046, Peru.
- Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo, 14012, Peru.
| | | | | | - Sanjit Sah
- Research Scientist, Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, 442001, India
- SR Sanjeevani Hospital, Kalyanpur-10, Siraha, Nepal
| | - Alfonso J Rodriguez-Morales
- Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima, 15067, Peru
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, 1102, Lebanon
| |
Collapse
|
3
|
Bhatnagar KR, Dixit SG, Pandey L, Prakash S, Shiromani S, Singh K. Digital eye strain among medical students associated with shifting to e-learning during COVID-19 pandemic: An online survey. Indian J Ophthalmol 2024; 72:98-104. [PMID: 38131578 PMCID: PMC10841805 DOI: 10.4103/ijo.ijo_492_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE This study aimed to determine the prevalence, risk factors, symptoms, and awareness of computer vision syndrome (CVS) among medical students during the coronavirus disease 2019 (COVID-19) pandemic. METHODS A cross-sectional observational study was conducted among 283 undergraduate medical students at a tertiary healthcare center. An electronic survey was conducted to collect the data. Data were analyzed using Statistical Package for Social Sciences (SPSS version 23). The Chi-square test (Fisher's exact test when required) was used to study the significance of associations. A P value <0.05 was considered statistically significant. RESULTS A high prevalence of CVS was observed in which 92% reported at least one symptom while using a digital device, the most frequent being eye strain (49%). Among extraocular complaints, joint pain in the wrist and fingers was most frequent. Significant association (P < 0.05) of CVS was found with increased duration of digital device usage, refractive error, use of glasses or contact lens, preexisting dry eye disease, and use of topical eye drops. 37% of the participants were aware of the 20-20-20 rule, while only 11% followed it. CONCLUSION CVS is a common health concern among medical students. Hence, to increase the productivity of work, significant risk factors need to be addressed and awareness must be raised.
Collapse
Affiliation(s)
| | | | - Latika Pandey
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | - Sujeet Prakash
- Department of Ophthalmology, AIIMS, Jodhpur, Rajasthan, India
| | | | - Kuldeep Singh
- Department of Paediatrics, AIIMS, Jodhpur, Rajasthan, India
| |
Collapse
|
4
|
Ccami-Bernal F, Soriano-Moreno DR, Romero-Robles MA, Barriga-Chambi F, Tuco KG, Castro-Diaz SD, Nuñez-Lupaca JN, Pacheco-Mendoza J, Galvez-Olortegui T, Benites-Zapata VA. Prevalence of computer vision syndrome: A systematic review and meta-analysis. JOURNAL OF OPTOMETRY 2024; 17:100482. [PMID: 37866176 PMCID: PMC10785422 DOI: 10.1016/j.optom.2023.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE This review aimed to estimate the prevalence of computer vision syndrome (CVS) in the general population and subgroups. METHODS A search was conducted in the following the databases: PubMed, SCOPUS, EMBASE, and Web of Science until February 13, 2023. We included studies that assessed the prevalence of CVS in any population. The Joanna Briggs Institute's critical appraisal tool was used to evaluate the methodological quality. A meta-analysis of the prevalence of CVS was done using a random-effects model, assessing the sources of heterogeneity using subgroup and meta-regression analyses. RESULTS A total of 103 cross-sectional studies with 66 577 participants were included. The prevalence of CVS was 69.0% (95% CI: 62.3 to 75.3; I2: 99.7%), ranging from 12.1 to 97.3% across studies. Point prevalence was higher in women than in men (71.4 vs. 61.8%), university students (76.1%), Africa (71.2%), Asia (69.9%), contact lens wearers (73.1% vs. 63.8%) in studies conducted before the COVID-19 pandemic (72.8%), and in those that did not use the CVS-Q questionnaire (75.4%). In meta-regression, using the CVS-Q scale was associated with a lower prevalence of CVS. CONCLUSION Seven out of ten people suffer from CVS. Preventive strategies and interventions are needed to decrease the prevalence of this condition which can affect productivity and quality of life. Future studies should standardize a definition of CVS.
Collapse
Affiliation(s)
- Fabricio Ccami-Bernal
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Santa Catalina 117, Arequipa 04000, Peru
| | - David R Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Universidad Peruana Unión, Lima, Carretera Central Km 19.5 Ñaña, Chosica, 15464 Peru
| | | | - Fernanda Barriga-Chambi
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Santa Catalina 117, Arequipa 04000, Peru
| | - Kimberly G Tuco
- Unidad de Investigación Clínica y Epidemiológica, Universidad Peruana Unión, Lima, Carretera Central Km 19.5 Ñaña, Chosica, 15464 Peru
| | - Sharong D Castro-Diaz
- Unidad de Investigación Clínica y Epidemiológica, Universidad Peruana Unión, Lima, Carretera Central Km 19.5 Ñaña, Chosica, 15464 Peru
| | - Janeth N Nuñez-Lupaca
- Escuela Profesional de Medicina Humana, Universidad Nacional Jorge Basadre Grohmann, Tacna, Miraflores S/N, 23000 Peru
| | | | - Tomas Galvez-Olortegui
- Unidad de Oftalmología Basada en Evidencias (Oftalmoevidencia), Scientia Clinical and Epidemiological Research Institute, Trujillo, Mz. G Lt. 22 Urb. Vista Hermosa, 13001 Peru; Departamento de Oftalmología, Hospital Nacional Guillermo Almenara Yrigoyen, Jirón García Naranjo 840, La Victoria 13, Lima 15033, Peru
| | - Vicente A Benites-Zapata
- Unidad de investigación para la Generación y Síntesis de Evidencias en Salud (UGIES), Universidad San Ignacio de Loyola, Av. La Fontana 550, La Molina, Lima 15024, Peru.
| |
Collapse
|
5
|
Sengo DB, da Deolinda Bernardo Pica A, Dos Santos IIDB, Mate LM, Mazuze AN, Caballero P, López-Izquierdo I. Computer vision syndrome and associated factors in university students and teachers in Nampula, Mozambique. BMC Ophthalmol 2023; 23:508. [PMID: 38093208 PMCID: PMC10720210 DOI: 10.1186/s12886-023-03253-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Computer Vision Syndrome (CVS) is a complex of eye and visual problems that arise while using a computer or other Video Display Terminal (DVT). With the advent of the COVID-19 pandemic, the use of these DVTs has become indispensable in the lives of students and teachers. This study aims to identify the prevalence of CVS and associated factors in students and teachers at Lúrio University, in Nampula, during the pandemic period. METHODS This is a cross-sectional study, carried out between November 2020 and March 2021. The validated CVS questionnaire (CVS-Q) and another semi-structured questionnaire on ergonomic risk factors were applied. Odds ratios (OR) and adjusted odds ratios (aOR) were calculated to measure the association between CVS and computer use conditions. RESULTS The prevalence of CVS was 76.6%, and the female gender, age ≤ 20 years, levels I, II, III of course, lack of knowledge about ergonomics, use the computer to study, use more than 6 hours daily, absence of anti-reflex treatment, use of other devices and sitting in an inappropriate chair were risk factors for the occurrence of CVS, while being a teacher was a protective factor. CONCLUSION The prevalence of CVS found in this study was high, due to several factors, especially not using ergonomic principles when using computers and other DVTs. There is a need to adopt intervention strategies focused on the most vulnerable groups such as women, age group ≤20 years and students, especially at the first year level, right after entering the University.
Collapse
Affiliation(s)
- Dulnério Barbosa Sengo
- Instituto Superior de Ciências da Saúde, Av. Tomás Nduda, nr. 977 RC, Cidade de Maputo, Mozambique.
| | | | | | - Laura Mavota Mate
- Ministério dos Combatentes, Av Mártires Machava, nr. 307, Cidade de Maputo, Moçambique
| | - Avelino Nelson Mazuze
- Universidade Lúrio, faculdade Ciências de Saúde, Bairro de Marrere, R. nr, 4250, Nampula, Mozambique
| | - Pablo Caballero
- Universitat d'Alacant, Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Carretera Sant Vicent del Raspeig s/n, 03690, Sant Vicent del Raspeig, Alacant, Spain
| | - Inmaculada López-Izquierdo
- Universidad de Sevilla, Departamento de Física de la Materia Condensada, Av. Reina Mercedes s/n, 41012, Sevilla, Spain
| |
Collapse
|
6
|
Iqbal M, Soliman A, Ibrahim O, Gad A. Analysis of the Outcomes of the Screen-Time Reduction in Computer Vision Syndrome: A Cohort Comparative Study. Clin Ophthalmol 2023; 17:123-134. [PMID: 36644605 PMCID: PMC9833323 DOI: 10.2147/opth.s399044] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose To analyze the outcomes of screen-time reduction on the foveal responses that associates computer vision syndrome (CVS) using multifocal electroretinogram (mfERG) examination. Methods This prospective multicenter cohort comparative study included 49 eyes of 49 medical students divided into two groups. Group A (control group) included 25 eyes with no CVS diagnosis while group B (CVS group) included 24 eyes with CVS diagnosis. All students responded to the valid and reliable CVS-Form 3 (CVS-F3) questionnaire and underwent complete ophthalmic and mfERG examinations twice at the time recruitment in the study and four weeks after strict reduction of the daily screen-hours to ≤1 screen-hour daily to document associated foveal responses. Results We documented statistically significant reduction in foveal responses in CVS versus control groups in mean mfERG Rings 1, 2, and 5 with Quadrants 1, 2, and 4 (P=<0.0001, 0.0001, 0.0003, 0.001, 0.002, and 0.006, respectively). Following the screen-time reduction, the second mfERG examination revealed significant post-reduction improvements in foveal responses in CVS group particularly in mean mfERG Rings 1, 2, 3, and 5 with Quadrants 1 and 4 (P=<0.0001, <0.0001, 0.0005, 0.02, <0.0001, and 0.04, respectively). Conclusion This study documented the screen-induced foveal dysfunction that associates CVS using mfERG examination, which revealed remarkable significant improvements in foveal responses in the 4 weeks following strict screen-time reduction. These improvements were also associated with corresponding improvements in the visual performances. We suggest that the potential screen-induced foveal dysfunction outcomes might be reversible with strict screen-time reduction. We also recommend that educational institutional policies should limit online education-hours and redesign the mandated computer system use program to guard against visual sequelae of CVS. Clinical Trials Registration ClinicalTrials.gov (ID: NCT04405648).
Collapse
Affiliation(s)
- Mohammed Iqbal
- Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt,Correspondence: Mohammed Iqbal, Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, 82425, Egypt, Tel +2 01068559840, Fax +2 093 2159080, Email
| | - Ashraf Soliman
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ola Ibrahim
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Gad
- Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt
| |
Collapse
|
7
|
Uwimana A, Ma C, Ma X. Concurrent Rising of Dry Eye and Eye Strain Symptoms Among University Students During the COVID-19 Pandemic Era: A Cross-Sectional Study. Risk Manag Healthc Policy 2022; 15:2311-2322. [PMID: 36518997 PMCID: PMC9743979 DOI: 10.2147/rmhp.s388331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/23/2022] [Indexed: 10/20/2023] Open
Abstract
PURPOSE Students spend extended hours using electronic devices due to online teaching. Digital eye strain (DES) and dry eye disease (DED) symptoms are both associated with prolonged screen exposure time and may co-occur. This study aimed to evaluate the correlation between DES and DED symptoms and determine the prevalence of DED according to the severity of DES. PATIENTS AND METHODS This cross-sectional study was conducted among international students in Chinese universities. The survey was built using Wenjuan Mini Program and distributed using the WeChat platform. The questionnaire assessed participants' screen exposure, the 20-20-20 rule, ED practices, and DED awareness. Computer Vision Syndrome Questionnaire (CVS-Q) and Dry Eye Questionnaire (DEQ-5) were used to diagnose DES and DED symptoms, respectively. RESULTS 498 students completed the survey, but 452 were considered for the study. Predictors of DES and DED symptoms were conjunctivitis, eye allergy, glares, tired eye, neck pain, back pain, PhD students, and daily spending > 9h on screen (P < 0.05 for all). We observed that an increase in DES scores also exponentially increases DED scores. Among students diagnosed with DES symptoms, 26.5% had mild to moderate DED symptoms, and 8.2% had severe DED symptoms. In contrast, only 8.4% and 0.9% of those with asymptomatic DES had mild to moderate and severe DED symptoms, respectively (P < 0.000). A strong and significant positive correlation (r = 0.695, P < 0.000) between DES and DED scores was found. CONCLUSION We found an extremely high prevalence of DES and DED symptoms compared to the previous studies with a similar population group. We believe that the prevalence of DED may be underestimated in the young population. Training about proper ED practices is mandatory to prevent these deleterious ocular surface conditions.
Collapse
Affiliation(s)
- Alexandre Uwimana
- Department of Ophthalmology, the First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Cong Ma
- Department of Ophthalmology, the First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Xiang Ma
- Department of Ophthalmology, the First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China
| |
Collapse
|
8
|
Roy S, Sharif AB, Chowdhury S, Iktidar MA. Unavoidable online education due to COVID-19 and its association to computer vision syndrome: a cross-sectional survey. BMJ Open Ophthalmol 2022. [PMCID: PMC9527743 DOI: 10.1136/bmjophth-2022-001118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background During the COVID-19 pandemic, online education and entertainment have increased significantly due to strict isolation and frequent lockdowns. This study intended to explore the prevalence and potential factors associated with computer vision syndrome (CVS) among the postsecondary students of Bangladesh pursuing online education. Methods In total, there were 917 postsecondary students participated in this study. Information on sociodemographic variables, and CVS symptom-related variables were collected using a prevalidated self-administered questionnaire. The CVS questionnaire was used to assess an individual’s CVS status. The bivariate association between CVS and other categorical variables was obtained using a χ2 test. A multivariable logistic regression model was used to explore variables associated with the CVS. Results The overall prevalence of CVS was 68.16%. Most common symptoms were headache (42.4%), feeling of worsening eyesight (23.2%), and eye pain (23.2%). CVS was associated with educational status (p=0.03), family history of eye-related problems (p<0.001), personal history of eye-related problems (p<0.001), usage of eye accessories (p<0.001), type of device used for online education (p<0.01), average daily use (p<0.01), and usage pattern (p=0.02). After adjusting for confounders, CVS was significantly related to the use of mobile or tablet (adjusted OR, AOR 8.954, 95% CI 1.57 to 51.063), continuing online education for more than 12 hours/day without any break or insufficient break (AOR 7.654, 95% CI 1.625 to 36.053), and previous family (AOR 3.189, 95% CI 1.751 to 5.811) or personal history of eye problems or headaches, or insomnia (AOR 6.214, 95% CI 2.783 to 13.878). Conclusion A high prevalence of CVS was observed among the post-secondary students in Bangladesh. Since an extensive use of digital screens is somewhat unavoidable during unprecedented times, such as COVID-19, educators should include CVS awareness and prevention in their curricula.
Collapse
Affiliation(s)
- Simanta Roy
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Azaz Bin Sharif
- Department of Public Health, North South University, Dhaka, Bangladesh
| | | | | |
Collapse
|