*3.2. Quality Assessment*

Twelve (34.3%) cross-sectional studies were deemed at moderate risk of bias, whereas 23 (65.7%) were classified as low-risk (Table 2). Nine (81.8%) cross-sectional studies were deemed to be medium-quality, whereas two (18.2%) were high-quality (Table 3).

**Table 2.** JBI risk of bias assessment table. Eight items per study were evaluated and the risk of bias was calculated on the number of positive answers. y = yes, n = no, u = unclear. Moderate = where positive answers were between 50% and 75%; low = where positive answers were above 75%.



**Table 3.** NOS quality assessment table. Each study was awarded one star per item within the selection and exposure categories. A maximum of two stars could be awarded for comparability. The score is the sum of the awarded stars and ranges from zero to nine.

"\*" : Each study was awarded one star per item. The score is the sum of the awarded stars, ranged from 0 to 9 (high-quality, >7 stars; medium-quality, 4–6 stars; poor-quality, <4 stars).
