{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:21:13Z","timestamp":1789172473051,"version":"build-2803163510"},"reference-count":110,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post-COVID syndrome, defined by the WHO as persistent multisystem symptoms extending beyond 4 weeks post-infection, has emerged as a critical public health concern in South Asia, a region home to approximately 1. 9 billion individuals across Pakistan, India and Bangladesh. Despite the disproportionate burden affecting an estimated 54.3 million individuals in this region, no prior systematic synthesis has integrated evidence across all three major South Asian countries, creating a significant gap in the evidence-based policy development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic narrative review, conducted following the PRISMA-ScR guidelines, synthesized evidence from 388 peer-reviewed publications identified through PubMed, Scopus, and Google Scholar databases (January 2020\u2013December 2023). Study quality was assessed using the JBI Critical Appraisal Checklist and the GRADE framework. Two independent reviewers performed the screening (inter-rater reliability: 87.3%) and data extraction (concordance: 94.1%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of post-COVID syndrome varied geographically: 15.8%\u221218.3% in Pakistan, 9.4%\u221222.5% to 11.2%\u221216.8% in India, Females consistently demonstrated higher prevalence across all countries, with ratios ranging from 1.41:1 to 1.81:1. The peak burden occurred in the 35\u201354 age group. Urban areas reported a higher prevalence than rural areas, with disparities correlating with healthcare infrastructure metrics. Fatigue (58.3%), brain fog (52.1%), and memory problems (48.7%) were the most prevalent symptoms. The prevalence declined across successive pandemic waves, with vaccination associated with substantial reductions in later waves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Post-COVID syndrome poses a substantial and ongoing public health challenge in South Asia, disproportionately affecting women and adults of working age. Urban-rural disparities in prevalence reflect underlying healthcare access inequities rather than true epidemiological differences. Urgent priorities include establishing dedicated post-COVID clinics, strengthening rehabilitation infrastructure, and conducting region-specific genetic and long-term outcome research to inform evidence-based interventions for this vulnerable population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1714880","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:48:40Z","timestamp":1779256120000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Post-COVID syndrome in Pakistan, India, and Bangladesh: a systematic narrative review of epidemiology, clinical manifestations, and healthcare system responses"],"prefix":"10.3389","volume":"14","author":[{"given":"Amani S.","family":"Alrossies","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University","place":["Riyadh Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1080\/10408363.2020.1860895","article-title":"COVID-19: from an acute to chronic disease? potential long-term health consequences","volume":"58","author":"Higgins","year":"2020","journal-title":"Crit Rev Clin Lab Sci."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e946512","DOI":"10.12659\/MSM.946512","article-title":"Long COpost-covidt-acute sequelae of SARS-CoV-infection (PASC) and the urgent need to identify diagnostic biomarkers and risk factors","volume":"30","author":"Parums","year":"2024","journal-title":"Med Sci Monit."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1093\/infdis\/jiac136","article-title":"Global prevalence of post-coronavirus disease 2019 (COVID-19) condition or long COVID: a meta-analysis and systematic review","volume":"226","author":"Chen","year":"2022","journal-title":"J Infect Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"4","DOI":"10.2139\/ssrn.4931063","article-title":"Long COVID clinical evaluation, research and impact on society: a global expert consensus","volume":"24","author":"Ewing","year":"2025","journal-title":"Ann Clin Microbiol Antimicrob."},{"key":"B5","doi-asserted-by":"publisher","first-page":"219","DOI":"10.33696\/immunology.6.209","article-title":"Epidemiology, symptoms and pathophysiology of long covid complications","volume":"6","author":"Zhang","year":"2024","journal-title":"J Cell Immunol."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1101\/2025.10.23.25338705","article-title":"A systematic scoping review and conceptual analysis of new-onset fibromyalgia manifestations after non-hospitalized COVID-19: empirics, definitions, methodologies, pathophysiology, mapping of literature, and knowledge gaps","author":"Plaut","year":"2025","journal-title":"medRxiv."},{"key":"B7","doi-asserted-by":"publisher","first-page":"377","DOI":"10.3390\/biomedicines11020377","article-title":"Mechanisms, effects, and management of neurological complications of post-acute sequelae of COVID-19 (NC-PASC)","volume":"11","author":"Ong","year":"2023","journal-title":"Biomedicines."},{"key":"B8","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1186\/s12913-023-09318-6","article-title":"Abhilasha, Mishra RS, Upadhyay AK, O'Donnell O, Maurer J. 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