Background Multidrug‐resistant tuberculosis (MDR‐TB) is a major global public health concern. However, there is a dearth of literature on whether MDR‐TB and its medications impact maternal and perinatal outcomes, and when such evidence exists the findings are conflicting. Objectives This systematic review and meta‐analysis aimed to examine the impact of MDR‐TB and its medications during pregnancy on maternal and perinatal outcomes. Search strategy PubMed, Scopus and Web of Science databases were searched from earliest to February 2020. Selection criteria Records were screened based on pre‐defined selection criteria and assessed for quality by two independent reviewers. Data collection and analysis A meta‐analysis was performed using the random effects model to calculate pooled prevalence for each outcome. Main results Of the 72 records identified, 12 were included in the systematic review and meta‐analysis, consisting of 174 pregnant women with MDR‐TB and 110 adverse outcomes. Maternal death, pregnancy loss, preterm birth and low birthweight were the most common maternal and perinatal adverse outcomes reported in the studies. The overall pooled prevalence was 7.5% (95% CI 3.2–12.8) for maternal death, 10.6% (95% CI 6.0–16.3) for pregnancy loss, 12.9% (95% CI 0.0–38.0) for preterm birth and 23.7% (95% CI 17.0–31.0) for low birthweight. Conclusions The findings suggest that MDR‐TB is associated with a high risk of adverse maternal and perinatal outcomes, but these should be interpreted cautiously because the evidence is largely preliminary. Adequately powered prospective cohort studies are urgently required to corroborate these findings. Tweetable abstract Multidrug‐resistant tuberculosis may increase the risk of adverse maternal and perinatal outcomes.

IntroductionMultidrug-resistant tuberculosis (MDR-TB) is a common public health problem affecting pregnant women. However, the impact of MDR-TB and its medication on pregnancy and perinatal outcomes has been poorly understood and inconsistently reported. Therefore, using the available literature, we aim to determine whether MDR-TB and its medications during pregnancy impact maternal and perinatal outcomes.Methods and analysisThis systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches will be conducted in PubMed, Scopus and Web of Science on 10 February 2020 for studies that reported adverse maternal and perinatal outcomes due to MDR-TB and/or its medication. The search will be performed without language and time restrictions. Adverse birth outcomes include miscarriage or abortion, stillbirth, preterm birth, low birth weight, small and large for gestational age, and neonatal death. Two independent reviewers will screen search records, extract data and assess the quality of the studies. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the methodological quality of the included studies. In addition to a narrative synthesis, a random-effects meta-analysis will be conducted when sufficient data are available. I2 statistics will be used to assess the heterogeneity between studies.Ethics and disseminationAs it will be a systematic review and meta-analysis based on previously published evidence, there will be no requirement for ethical approval. Findings will be published in a peer-reviewed journal and will be presented at various conferences.

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We present the results of a meta‐analysis of household‐size water demand elasticity. The analysis is based on 75 primary studies. As there is evidence of publication bias, publication bias–corrected estimates are reported. For indoor water use, we find that in countries with gross domestic product (GDP) per capita below $10,000, the household‐size elasticity is approximately 0.4–0.5, and in countries with GDP per capita above $10,000, it is approximately 0.5–0.6. For outdoor water use, we find that there is no increase in water use as household size increases, at low incomes (GDP less than $5000 per capita), but the effect becomes positive at higher incomes. In countries with a GDP per capita between $5000 and $15,000, the household‐size outdoor water use elasticity is approximately 0.1, and in countries with a GDP per capita above $15,000, it is approximately 0.2. The positive household‐size elasticity implies that the cost of meeting basic water needs, per person, increases with household size in countries that use increasing block pricing for water. The use of a single volumetric price, equal to marginal cost, combined with a fixed charge, would lessen this effect and also improve system efficiency.