METHODS: A school environment study was performed among randomly selected students in eight randomly selected secondary schools in Penang, Malaysia. Information on eye symptoms and demographic data was collected by a standardised questionnaire. BUT was measured by two methods, self-reported BUT (SBUT) and by the non-invasive Tearscope (NIBUT). Dust was collected by vacuuming in 32 classrooms and analysed for five fungal DNA sequences. Geometric mean (GM) for total fungal DNA was 7.31*104 target copies per gram dust and for Aspergillus/Penicillium DNA 3.34*104 target copies per gram dust. Linear mixed models and 3-level multiple logistic regression were applied adjusting for demographic factors.
RESULTS: A total of 368 students (58%) participated and 17.4% reported weekly eye symptoms the last 3 months. The median SBUT and TBUT were 15 and 12s, respectively. Students wearing glasses (OR 2.41, p=0.01) and with a history of atopy (OR=2.67; p=0.008) had more eye symptoms. Girls had less eye symptoms than boys (OR=0.34; p=0.006) Indoor carbon dioxide in the classrooms was low (range 380-720ppm), temperature was 25-30°C and relative air humidity 70-88%. Total fungal DNA in vacuumed dust was associated with shorter SBUT (4s shorter per 105 target copies per gram dust; p=0.04) and NIBUT (4s shorter per 105 target copies per gram dust; p<0.001). Aspergillus/Penicillium DNA was associated with shorter NIBUT (5s shorter per 105 target copies per gram dust; p=0.01).
CONCLUSION: Fungal contamination in schools in a tropical country can be a risk factor for impaired tear film stability among students.
METHODS AND ANALYSIS: We will systematically conduct a comprehensive literature search using various databases including PubMed, EMBASE, Scopus, CENTRAL and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to latest available studies in 2020. We will include all the observational studies such as cohort case-control and cross-sectional studies that explains or measures the effects of temperature and/or humidity and/or air quality and/or anthropic activities that is associated with SARS-CoV-2. Study selection and reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Meta-Analysis of Observational Studies in Epidemiology guideline. All data will be extracted using a standardised data extraction form and quality of the studies will be assessed using the Newcastle-Ottawa Scale guideline. Descriptive and meta-analysis will be performed using a random effect model in Review Manager File.
ETHICS AND DISSEMINATION: No primary data will be collected, and thus no formal ethical approval is required. The results will be disseminated through a peer-reviewed publication and conference presentation.
PROSPERO REGISTRATION NUMBER: CRD42020176756.