Study/Year published Country Duration of intervention | Design | Population | n | Risk of Bias a | Intervention | Control | Outcome | OR | RR | ||
---|---|---|---|---|---|---|---|---|---|---|---|
Azad [42] Bangladesh 2005 to 2007 | Cluster RCT 18 clusters | Women aged 15 to 49 years having given birth during the study period | 29,889 | 1. Low 2. Unclear 3. Unclear 4. Low 5.High 6.Low 7.Low Overall: High | Women’s education groups plus health system improvement | Control (health system improvement) | Antenatal care |  |  | ||
any | 0.78 [0.51, 1.19]* | 0.91 [0.76, 1.09]** | |||||||||
≥ 4 visits | 0.15 [0.06, 0.40]* | 0·79 [0.46, 1.37]*** | |||||||||
Skilled birth attendant formal provider | 0.45 [0.19, 1.11]* | 0.90 [0.72, 1.14]** | |||||||||
Delivery at a health care facility | 0.75 [0.62, 0.89]*** | 0.97 [0.77, 1.24]** | |||||||||
Maternal deaths | Â | Â | |||||||||
 2 years | – | 1.80 [1.2, 3.17]* | |||||||||
 3 years (N = number of live births for all outcomes above) | – | 1.67 [1.00, 2.79]* | |||||||||
 MMR (over 3 years) (live births per 100,000) | 388.9 vs. 189.10 | 2.02 [1.11, 3.68]** | |||||||||
1.74 [0.97, 3.13]# | |||||||||||
Baqui [49] Bangladesh 2003 to 2006 | Cluster RCT 24 clusters | All married women of reproductive age (15–49 years) | 5110 | 1.Low 2.Low 3.Unclear 4.Low 5.High 6.Low 7.Low Overall: High | Community mobilisation: home care by female mobilisers visiting every 8 months | control | Antenatal care Any (N = number of live births) | 1.70 [1.07, 2.68]* | 1.13 [0.93, 1.36]* | ||
Community mobilisation: Community care by male mobilisers visiting every 10Â months and female mobilisers visiting every 4Â months | control | Antenatal care | Â | Â | |||||||
Any (N = number of live births) | 2.67 [1.70, 4.21]* | 1.47 [1.21, 1.70]* | |||||||||
Community mobilisation: Both community and home care | control | Antenatal care | Â | Â | |||||||
Any (N = number of live births) | 2.13 [1.33, 3.39]* | 1.37 [1.15, 1.63]* | |||||||||
Bhutta [50] Pakistan 2006 to 2008 | Cluster RCT 16 clusters | Pregnant women and women of reproductive age (15–49 years) | 4474 | 1.Low 2.Unclear 3.Unclear 4.Low 5.Low 6.Low 7.Low Overall: Low | Community mobilisation | Healthcare workers (standard healthcare) | Antenatal care |  |  | ||
Any | 1.64 [1.03, 2.62]* | 1.20 [1.01, 1.42]* | |||||||||
≥ 4 visits | 1.51 [0.79, 2.88]* | 1.44 [0.75, 2.77]* | |||||||||
Delivery at a health care facility (any) (N = number of women for all outcomes) | 1.53 [1.36, 1.72]*** | 1.24 [1.17, 1.32]*** | |||||||||
Darmstadt [51] Bangladesh 2004 to 2006 | Cluster randomised trial 12 clusters | All married women of reproductive age (15–49 years) | 3491 | 1.Low 2.Unclear 3.Unclear 4.Low 5.Low 6.Low 7.Low Overall: Low | Community education by community health care workers | Control | Antenatal care |  |  | ||
Any | 2.29 [1.34, 3.91]* | 1.40 [1.12, 1.75]* | |||||||||
Skilled birth attendant | Not reported | Not reported | |||||||||
Delivery at health care facility (N = number of women for all outcomes) | 1.20 [0.62, 2.29]*** | 1.19 [0.63, 2.27]*** | |||||||||
Maternal danger sign knowledge score: | Mean score Intervention | Mean score Control | |||||||||
Pre | Post | Pre | Post | ||||||||
 a. Antenatal [0–10] | 1.0 | 2.9 | 1.1 | 2.2 | |||||||
 b. Labor/delivery [0–11] | 1.1 | 2.4 | 1.2 | 1.9 | |||||||
 c. Postpartum [0–9] | 1.0 | 2.5 | 1.0 | 2.5 | |||||||
Fottrell [52] Bangladesh 2005 to 2007 | Cluster randomised trial 18 Clusters | Ever-married women of reproductive age (15–49 years) who were permanent residents including in-laws and adolescent girls | 17,940 | 1.Low 2.Unclear 3.Unclear 4.Low 5.Low 6.Low 7.Unclear Overall: Low | Women’s education groups plus health system improvement | Control (health system improvement) | Antenatal care |  |  | ||
≥ 4 visits | 1.37 [0.99–1.88]** | 1.28 [0.13, 12.11]* | |||||||||
Skilled birth attendant | 0.54 [0.38, 0.78]** | 0.92 [0.71, 1.20]* | |||||||||
Delivery at health care facility (any) (N = number of births for above outcomes) | 1.05 [0.88, 1.25]** | 0.94 [0.55, 1.59]*** | |||||||||
Maternal deaths 2 years (N = number of live births) | – | 0.59 [0.30, 1.18]* | |||||||||
MMR (over 2Â years) (per 100,000 live births) | 153.4 vs. 276.10 | 0.74 [0.34, 1.64]** | |||||||||
Midhet** [53] Pakistan 1998–2002 | Cluster randomised trial 24 clusters | Women and men of reproductive age (all ever-married women under 50 years of age) | 2564 | 1.Low 2.Unclear 3.Unclear 4.Low 5.High 6.Unclear 7.Low Overall: High | Women’s and men’s education groups | Control | Antenatal care |  |  | ||
Any | 2.83 [1.60, 5.00]** | 1.35 [0.81, 2.25]* | |||||||||
Delivery at health care facility (any) (N = number of pregnant women for all outcomes) | 1.3 [0.6, 2.7]** | 1.28 [0.84, 1.96]*** | |||||||||
Women’s education groups | Control | Antenatal care |  |  | |||||||
Any | 2.45 [1.40, 4.30]** | 1.32 [0.79, 2.20]* | |||||||||
Delivery at a health care facility (N = number of pregnant women for all outcomes) | 1.3 [0.7, 2.5]** | 1.32 [0.86, 2.02]*** | |||||||||
Both interventions combined (women’s education groups and women’s and men’s education groups) | Control | Antenatal care |  |  | |||||||
Any | 1.38 [0.82, 1.34]* | 1.33 [0.84, 2.10]* | |||||||||
Delivery at health care facility (any) (N = number of pregnant women for all outcomes) | 1.46 [0.99, 2.15]*** | 1.43 [0.99, 2.07]*** | |||||||||
Osrin [54] Nepal 1998–2000 | Randomised trial 24 Clusters | Women (aged 15–49 years) and key members of the community in improving perinatal health outcomes | 4241 | 1.Low 2.Unclear 3.Unclear 4.Low 5.Low 6.Low 7.Low Overall: Low | Women’s education groups | Control | Antenatal care |  |  | ||
Any | 2.82 [1.41, 5.62]** | 1.32 [1.08, 1.60]* | |||||||||
(N = number of pregnancies) Skilled birth attendant |  |  | |||||||||
Any | 2.50 [1.51, 4.16]* | 2.26 [1.43, 3.57]* | |||||||||
formal health provider (doctor or nurse) | 3.13 [1.62, 6.03]** | 2.96 [1.50, 5.84]* | |||||||||
Traditional birth assistant (N = number of deliveries) | 1.70 [0.93, 3.11]** | 1.71 [0.89, 3.31]* | |||||||||
Delivery at health care facility | 3.54 [1.56, 8.05]** | 3.38 [2.57, 4.45]*** | |||||||||
Maternal deaths 2Â years | Â | 0.18 [0.14, 0.24]* | |||||||||
MMR (over 3Â years) (per 100,000 live births) | 69 vs 341 | 0.22 [0.05, 0.90]** | |||||||||
Sharma 2018 [34] Nepal | Pre and post-test randomised | All community members (all ages eligible) | 1572 | 1.Low 2.Unclear 3.Unclear 4.Low 5.Low 6.Low 7.Unclear Overall: Low | Community mobilisation: Community singing to deliver healthcare messages | Control | 1. Mean change in knowledge scores (se): | Â | Â | ||
a. Importance of antenatal examination (out of 7) | 2·12 [0·06] vs 4.89 [0.06] |  | |||||||||
b. Importance of supplementary diet and rest during pregnancy (out of 9) | 3·71 [0·07] vs 6·84 [0·06] | 0.12 [−0.22, 0.46] | |||||||||
c. Importance of delivery care (out of 12) | 2·95 [0·08] vs 5·09 [0·07] |  | |||||||||
d. Importance of childbirth planning (out of 8) | 2·81 [0·08] vs 5·50 [0·06] | −0.71[−1.3, −0.11] | |||||||||
e. Overall knowledge (out of 36) | 11·60 [0·24] vs 22·33 [0·18] | −1.02 [−2, −0.03] | |||||||||
Tripathy 2010 [55] India 2005 to 2008 | Cluster RCT 18 clusters | Women of reproductive age (15–49 years) | 17,335 | 1.Low 2.Unclear 3.Unclear 4.Low 5.Unclear 6.Low 7.Unclear Overall: Unclear | Women’s education groups plus health system improvement | Control (health system improvement) | Antenatal care |  |  | ||
Any | 0.97 [0.48, 1.97]** | 1.11 [0.99, 1.23]* | |||||||||
1·60 (0·65–3·92)# |  | ||||||||||
>  3 visits | 0.68 [0.37, 1.24]** | 0.70 [0.57, 0.87] * | |||||||||
Skilled birth attendant | Â | Â | |||||||||
Any | 0.52 [0.37, 0.74]** | 0.70 [0.57, 0.87]* | |||||||||
Formal provider | 0.59 [0.37, 0.94]* | 0.67 [0.46, 1.00]* | |||||||||
Traditional birth assistant | 0.82 [0.43, 1.56]* | 0.88 [0.68, 1.13]* | |||||||||
Delivery at health care facility(any) (N = number of pregnant women for all outcomes) | 0.64 [0.39, 1.04]** | 0.71 [0.66, 0.75]*** | |||||||||
Maternal deaths | Â | Â | |||||||||
 2 years |  | 0.82 [0.51, 1.33]* | |||||||||
 3 years |  | 0.77 [0.53, 1.13]* | |||||||||
MMR (over 3Â years) (per 100,000 live births) | 517.5 vs 680.3 | 0.70 [0.46, 1.07]** | |||||||||
Tripathy 2016 [56] India 2009 to 2012 | Randomised Controlled Trial 30 clusters | Women of reproductive age (15–49 years) | 7100 | 1.Low 2.Unclear 3.Unclear 4.Low 5.Unclear 6.Low 7.Low Overall: Unclear | Women’s education groups plus health system improvement | Control (health system improvement) | Antenatal Care |  |  | ||
Any | 0.82 [0.35, 1.92]** | 0.90 [0.75, 1.07]* | |||||||||
0·63 [0·35–1·16]# | 1.17 [0.78, 1.77]* | ||||||||||
> = 3 visits (N = number of births) | 1.08 [0.58, 2.01]* | 1.16 [1.12, 1.20]** | |||||||||
Delivery at health care facility | 1.23 [0.58, 2.60]** | 0.63 [0.25, 1.42]** | |||||||||
Maternal deaths 2 years (N = number of live births for all of the above outcomes) | – | 0.63 [0.26, 1.55]* | |||||||||
MMR (over 2Â years) (per 100,000 live births) | 222 vs. 349 0.63 [0.25, 1.42]*** | Â |