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Table 1 Characteristics of studies. Community interventions versus health services, standard care or control

From: Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia

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

  

 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 10 months and female mobilisers visiting every 4 months

control

Antenatal care

  

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

  

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 2 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

2 years

 

0.18 [0.14, 0.24]*

MMR (over 3 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):

  

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

  

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

  

 2 years

 

0.82 [0.51, 1.33]*

 3 years

 

0.77 [0.53, 1.13]*

MMR (over 3 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 2 years)

(per 100,000 live births)

222 vs. 349

0.63 [0.25, 1.42]***

 
  1. aRisk of Bias tool (Cochrane)
  2. *Adjusted estimate using outcome specific ICC
  3. **Adjusted estimate reported by authors – adjusted for clustering and stratification
  4. ***Unadjusted estimate reported by authors
  5. #Adjusted estimate reported by authors – adjusted for clustering, stratification and baseline covariates