Summary of findings for the main comparison. Agricultural education with post‐harvest technologies compared to usual agricultural support for reducing aflatoxin exposure in pregnant and lactating women, infants, and children to improve childhood growth.
| Agricultural education with post‐harvest technologies compared to usual agricultural support for reducing aflatoxin exposure in pregnant and lactating women, infants, and children to improve childhood growth | ||||||
| Patient or population: pregnant and lactating women, infants, and children Setting: households or communities in low‐ and middle‐income countries Intervention: agricultural education, with post‐harvest technologies to reduce aflatoxin exposure Comparison: usual agricultural support | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with usual agricultural support | Risk with agricultural education, with food replacement or post‐harvest technologies | |||||
| Birth length for gestational age z‐score | ‐ | ‐ | ‐ | (0 trials) | ‐ | ‐ |
| Birth weight for gestational age z‐score | ‐ | ‐ | ‐ | (0 trials) | ‐ | ‐ |
|
Low birth weight (less than 2500 g) |
‐ | ‐ | ‐ | (0 trials) | ‐ | ‐ |
|
Length‐ or height‐for‐age z‐score (LAZ) |
‐ | ‐ | ‐ | (0 trials) | ‐ | ‐ |
|
Stunting (LAZ ≥ 2 SD below reference median value) |
‐ | ‐ | ‐ | (0 trials) | ‐ | ‐ |
|
Weight‐for‐height z‐score (WHZ) |
‐ | ‐ | ‐ | (0 trials) | ‐ | ‐ |
| Unintended effects of agricultural and nutritional education interventions to reduce the aflatoxin intake of infants, children, pregnant and lactating women | ‐ | ‐ | ‐ | (0 trials) | ‐ | ‐ |
|
Weight‐for‐age z‐score (WAZ) Follow‐up: mean 6 months |
The mean WAZ was ‐0.47 z‐scorea | MD 0.57 z‐score higher (0.16 higher to 0.98 higher) | ‐ | 249 (1 RCT) |
⊕⊝⊝⊝ Very lowb,c,d | There is very uncertain evidence about the effect on WAZ when agricultural education, along with post‐harvest technologies to reduce aflatoxin exposure is compared to usual support or no intervention. |
|
Proportion of underweight children (WAZ ≥ 2 SD below reference median value) Follow‐up: mean 6 months |
The mean proportion of underweight children was 9.0%a | MD 6.7% lower (12.6% lower to 0.8% lower) | 249 (1 RCT) |
⊕⊝⊝⊝ Very lowb,c,d | The evidence is very uncertain about the effect on the proportion of underweight children when agricultural education, along with post‐harvest technologies to reduce aflatoxin exposure, is compared to usual support or no intervention. | |
| *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; RR: Risk ratio; OR: Odds 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. | ||||||
aMean post‐intervention value in the control group reported by a single cluster‐RCT (Kamala 2018a) bDowngraded by 1 for risk of bias: high risk of attrition bias cDowngraded by 1 for indirectness: one study conducted in a single setting dDowngraded by 1 for imprecision: optimal information size not met