Table 2.
Quality assessment of studies of community case management for the treatment of pneumonia
| Quality Assessment | Summary of Findings | |||||||
|---|---|---|---|---|---|---|---|---|
| Directness | No of events | |||||||
| No of studies | Design | Limitations | Consistency | Generalizability to population of interest | Generalizability to intervention of interest | Intervention | Control | Relative Risk (95% CI) |
| ALRI mortality 0–1 months: moderate outcome specific quality of evidence | ||||||||
| Four | Concurrent | No Major | 3 of 4 studies show benefit | Africa and Asia | 3 of 4 studies WHO case management by local health workers | 384 | 686 | 0.58 (0.44–0.77) |
| ALRI specific mortality 0–1 year: moderate outcome specific quality of evidence | ||||||||
| Six | Concurrent | No major limitations | Heterogeneity from meta-analysis, All studies show benefit | Africa and Asia | 4 of 6 studies WHO case management | 916 | 1510 | 0.59 (0.46–0.75) |
| Two | Before/After | High ALRI incidence | Heterogeneity from meta-analysis, All studies show benefit | Asia | 1 of 2 studies WHO case management | 7 | 34 | 0.36 (0.16–0.82) |
| Seven | Concurrent; before/ after | See Above | Heterogeneity from meta-analysis, All studies show benefit | Africa and Asia | See Above | 917 | 1522 | 0.57 (0.44–0.75) |
| Nine | Concurrent; before/ after | See Above | Heterogeneity from meta-analysis, All studies show benefit | Africa and Asia | See Above | 938 | 1569 | 0.58 (0.50– 0.67) |
| ALRI-specific mortality 1–4 years: low outcome specific quality of evidence | ||||||||
| Two | Before/After | High ALRI incidence | Both studies show benefit | Asia | 1 of 2 studies WHO case management | 10 | 24 | 0.51 (0.24–1.07) |
| ALRI-specific mortality 0-4 years: moderate outcome specific quality of evidence | ||||||||
| Eight | Concurrent | No major limitation | Five of eight studies show benefit | Africa and Asia | 6 of 8 studies WHO case management | 705 | 948 | 0.68 [0.53, 0.86] |
| Six | Before/After | No major limitation | Four of six studies show benefit | Africa and Asia | 3 of 5 studies WHO case management | 220 | 271 | 0.77 [0.54, 1.08] |
| Ten | Concurrent; before/ after | See Above | Eight of ten studies show benefit | Africa and Asia | See Above | 724 | 986 | 0.67 [0.51, 0.88] |
| Eleven | Concurrent; before/ after | See Above | Nine of eleven studies show benefit | Africa and Asia | See Above | 744 | 1032 | 0.68 [0.53, 0.88] |
| All cause mortality 0–1months: moderate outcome specific quality of evidence | ||||||||
| Five | Concurrent | No major limitation | All studies show benefit | Africa and Asia | 4 of 5 studies WHO case management | 925 | 957 | 0.73 (0.65– 0.82) |
| All-cause mortality 0–1 year: moderate outcome specific quality of evidence | ||||||||
| Six | Concurrent | No Major limitation | All studies show benefit | Africa and Asia | 4 of 6 studies WHO case management | 2095 | 2487 | 0.78 (0.71– 0.85) |
| Two | Before/After | High ALRI incidence | All studies show benefit | Asia only | 1 of 2 studies WHO case management | 41 | 100 | 0.60 (0.42–0.85) |
| Seven | Concurrent; before/ after | See above | All studies show benefit | Africa and Asia | See above | 2114 | 2524 | 0.77 (0.70– 0.85) |
| Nine | Concurrent; before/ after | See Above | All studies show benefit | Africa and Asia | See above | 2230 | 2703 | 0.79 (0.72–0.86) |
| All-cause mortality 1–4 years: low outcome specific quality of evidence | ||||||||
| Two | Before/After | High ALRI incidence | Both studies show benefit | Only Asia | 1 of 2 studies WHO case management | 43 | 82 | 0.49 (0.34–0.70) |
| All-cause mortality 0–4 years: moderate outcome specific quality of evidence | ||||||||
| Nine | Concurrent | No major limitation | Six studies show benefit | Africa and Asia | 6 of 9 studies WHO case management | 3115 | 4180 | 0.83 [0.73, 0.95] |
| Six | Before/After | No major limitation | Four studies show benefit | Africa and Asia | 3 of 6 studies WHO case management | 1141 | 1063 | 0.90 [0.64, 1.26] |
| Eleven | Concurrent; before/ after | No major limitation | See Above | Africa and Asia | See Above | 3113 | 4401 | 0.80 [0.77, 0.83] |
| Twelve | Concurrent; before/ after | No major limitation | See Above | Africa and Asia | See Above | 3214 | 4473 | 0.80 [0.77, 0.83] |