Summary of findings 4. Community health educational intervention for family members and mothers and for mothers only (subgroup) compared to control in LMICs.
| Community health educational intervention for family members and mothers and for mothers only (subgroup) compared to control in LMICs | ||||
| Patient or population: developing countries Setting: low‐middle‐income countries, community Intervention: community health educational intervention for family members and mothers and for mothers only (subgroup) Comparison: control | ||||
| Outcomes | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments |
| Neonatal mortality ‐ Intervention given to mothers and family members | RR 0.84 (0.74 to 0.95) | 282,817 (13 RCTs) | ⊕⊕⊝⊝ Lowa,b | Studies that were weighted the highest had the greatest concerns for risk of bias. Not all confidence intervals from these studies overlap, and the direction of effect shows inconsistency across studies |
| Neonatal mortality ‐ Intervention given to mothers only | RR 0.90 (0.77 to 1.05) | 270294 (13 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | An even split of studies presented with risk of bias that may have impacted the results. The confidence interval includes both important benefit or harm and no effect, but the total number of events appears to be sufficient |
| Early neonatal mortality ‐ Intervention given to mothers and family members | RR 0.70 (0.56 to 0.87) | 99,097 (7 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | There was a combination of high and unclear risk of bias regarding blinding; this can be attributed mainly to the cluster‐randomised design. The study with the greatest risk of bias concerns had the smallest weighting. Heterogeneity is high (I² = 88%) and not all confidence intervals overlap; one study is inconsistent in terms of direction of effect. The confidence interval is wide; however the sample size is sufficient |
| Early neonatal mortality ‐ Intervention given to mothers only | RR 0.78 (0.68 to 0.90) | 222,491 (8 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | There was a combination of high and unclear risk of bias regarding blinding; this can be attributed mainly to the cluster‐randomised design. The study with the greatest risk of bias concerns had the smallest weighting. Most of the confidence intervals overlap, a small amount of inconsistency regarding direction of effect is evident. The confidence interval is wide; however the sample size is sufficient |
| Late neonatal mortality ‐ Intervention given to mothers and family members | RR 0.69 (0.51 to 0.92) | 76,388 (4 RCTs) | ⊕⊕⊝⊝ Lowb,c | I² (49%) is low; all studies are consistent in direction; however some studies cross the line of no effect. The confidence interval is wide; however the sample size is sufficient |
| Late neonatal mortality ‐ Intervention given to mothers only | RR 0.50 (0.31 to 0.78) | 110,255 (7 RCTs) | ⊕⊝⊝⊝ Very lowa,b,c | High risk of bias was present for blinding across studies; however studies were cluster‐randomised trials, and this is justifiable I² (92%) is considerably large; not all confidence intervals of these studies overlap; however some consistency in the direction of effect is evident The confidence interval is wide; however the sample size is sufficient |
| Perinatal mortality ‐ Intervention given to mothers and family members | RR 0.83 (0.72 to 0.96) | 141,824 (7 RCTs) | ⊕⊕⊝⊝ Lowa,b | Several studies with greater weighting were at considerable risk of bias in areas (random sequence generation) that may have impacted the outcome Slight inconsistency in the direction of effect is evident between studies, and wide confidence intervals do not all overlap |
| Perinatal mortality ‐ Intervention given to mothers only | RR 0.83 (0.72 to 0.96) | 120,789 (8 RCTs) | ⊕⊕⊝⊝ Lowa,b | Several studies with greater weighting were at considerable risk of bias in areas (random sequence generation) that may have impacted the outcome There is slight inconsistency in the direction of effect between studies, and wide confidence intervals do not all overlap |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; LMICs: low‐ and middle‐income countries; RCT: randomised controlled trial; RR: risk ratio. | ||||
| GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||
aRisk of bias.
bInconsistency.
cImprecision.