A systematic review and meta-analysis on the utilization of ayush systems of medicine in India’s COVID response

The COVID-19 pandemic was unlike anything the world had ever seen, and the whole world grappled with this scourge. Although currently the COVID-19 pandemic is no longer a public health challenge, the unprecedented utilization and integration of Ayush therapeutics and principles for the COVID-19 response represent a critical health systems and policy experiment which needs a systematic evaluation. A systematic review and meta-analysis was conducted, and the data were extracted till 9th July 2024 using three databases: Scopus, PubMed and DOAJ and a total of seven articles were included for the review, following the PICOS criteria of inclusion and exclusion. Of the 667 articles, seven articles were finally selected, and these articles underwent quality assessment using the AXIS assessment tool. The pooled proportion of the Indian population that utilized the Ayush systems was estimated at a 95% confidence interval, using a random effects model assuming potential heterogeneity. The pooled estimate, publication bias, heterogeneity and sensitivity analysis were graphically represented using a forest, funnel, Galbraith plots and leave-one-out meta-analysis. Additionally, the effects of the small studies were assessed using Egger’s and Begg’s tests. The total sample across the included studies was 789,735. Of the seven articles, six focused on the general population, and five focused on the utilization of the Ayurveda system of medicine. The pooled proportion of the Indian population that utilized the Ayush systems for COVID-19 was 40% (95% CI: 25% − 57%). Based on the policy relevance, risk of exposure, access to guidelines and pattern of utilization two subgroup analyses were carried out. Utilization of multiple systems of Ayush (48%) and utilization among the general population (46%) showed the highest proportion compared to Ayurveda and healthcare workers, respectively. The high heterogeneity (I2 = 99.98%) suggests that the pooled estimate should be interpreted with caution, and the sensitivity analysis found one study had a modest upward influence on the overall estimate. This systematic review found a 40% pooled estimate of utilization of Ayush systems from the included studies, suggesting the utilization of these systems to manage mild and asymptomatic conditions and for preventive purposes.