Prevalence of Tobacco Pouch Keratosis in India: A Systematic  Review and Meta-Analysis Protocol

Chandru Sivamani; Kavipriya Outtamane; Sombuddha Biswas; Kavya S; Mamta Mor; Revathy Ajayan; Sooriyaprasannan Sriram

doi:10.31557/apjec.2093.20251026

Authors

Chandru Sivamani Care Max Foundation, Puducherry, India.
Kavipriya Outtamane Chief Dental Surgeon (NFSG), Mobile Dental Unit, Office of the Programme Officer, National Programme for Control of Blindness, Government of Puducherry, Puducherry, India. State Nodal Officer, National Oral Health Programme, Government of Puducherry, Puducherry, India.
Sombuddha Biswas Care Max Foundation, Puducherry, India.
Kavya S Care Max Foundation, Puducherry, India.
Mamta Mor Care Max Foundation, Puducherry, India.
Revathy Ajayan Care Max Foundation, Puducherry, India.
Sooriyaprasannan Sriram Care Max Foundation, Puducherry, India.

DOI:

https://doi.org/10.31557/apjec.2093.20251026

Keywords:

Oral potentially malignant disorder; Smokeless tobacco; Tobacco pouch keratosis (TPK); India

Abstract

Background: Tobacco pouch keratosis (TPK) is a common oral mucosal lesion among smokeless tobacco users, with potential for malignant transformation. Despite its public health importance, pooled prevalence estimates for India remains limited.

Methods: A comprehensive search will be conducted in PubMed, Embase, and Scopus, along with grey literature sources (Google Scholar and Shodhganga). Observational epidemiological studies published from 2000 onwards, reporting the prevalence of TPK in India, will be included. Forward and backward citation searches will also be performed. The study selection process will be documented using the PRISMA 2020 flow diagram. Data will be extracted using the Joanna Briggs Institute (JBI) standardized form, and methodological quality will be assessed using the JBI Critical Appraisal Checklist for prevalence studies. Key study characteristics and results will be tabulated, and provide a narrative synthesis. Pooled prevalence will be estimated using a random-effects model (restricted maximum likelihood method), with heterogeneity assessed via Cochran’s Q and I² statistics. If fewer than five studies are available, the Hartung Knapp Sidik Jonkman method will be applied. Subgroup analyses will be performed by age group, gender, and study setting. Publication bias will be evaluated using funnel plots and Egger’s test. The certainty of evidence will be graded using the GRADEpro framework.

Discussion: This review will generate pooled prevalence estimates of TPK across diverse populations and settings in India and will also provide evidence-based insights for researchers, clinicians, public health professionals, and policymakers involved in tobacco control and oral health initiatives.