Intervention effects on morbidity and access to care outcomes
| Country | Design* | Population/condition† | Reported measure of effect (95% CIs)‡ | Calculated RR (95% CIs)§ |
| Prevalence of infectious diseases¶ | ||||
| DR52 | cNRCT | Diarrhoea, children under two | AOR=0.99 (0.59 to 1.67) | 0.95 (0.61 to 1.47) |
| India48 | cRCT | Infant** diarrhoea | ARR=0.63 (0.49 to 0.80) | 0.63 (0.54 to 0.74) |
| India48 | cRCT | Infant** pneumonia | ARR=0.60 (0.46 to 0.78) | 0.56 (0.40 to 0.77) |
| Mali42 | BA | Childhood febrile illness | PR=0.61; p<0.001 | 0.61 (0.51 to 0.73) |
| Mali43 | BA | Childhood febrile illness | AOR=0.45 (0.32 to 0.62) | 0.57 (0.47 to 0.68) |
| Senegal45†† | CBA | Malaria, all ages | AOR=0.03 (0.02 to 0.07) | 0.06 (0.02 to 0.18) |
| SA39 | cRCT | Infant diarrhoea at 12 weeks | RR=1.01 (0.90 to 1.14) | 1.02 (0.90 to 1.16) |
| Prevalence of nutritional outcomes‡‡ | ||||
| DR52†† | cNRCT | Stunting, children under 2 | AOR=0.50 (0.22 to 1.10) | 0.61 (0.33 to 1.11) |
| DR52†† | cNRCT | Overweight, children under 2 | AOR=0.43 (0.23 to 0.77) | 0.69 (0.47 to 1.03) |
| DR52†† | cNRCT | LAZ scores, children under 2 | MD=0.21 (-0.02 to 0.44) | NA |
| DR52†† | cNRCT | BAZ scores, children under 2 | MD=−0.31 (-0.49 to -0.12) | NA |
| India48 | cRCT | Infant stunting | ARR=0.99 (0.94 to 1.04) | 1.03 (0.93 to 1.14) |
| India48 | cRCT | Infant wasting | ARR=1.10 (0.90 to 1.36) | 1.16 (0.93 to 1.46) |
| SA39 | cRCT | Infant LAZ scores at 12 weeks | MD=0.11 (0.03 to 0.19) | NA |
| SA39 | cRCT | Infant WLZ scores at 12 weeks | MD=0.01 (-0.07 to 0.09) | NA |
| SA39 | cRCT | Infant WAZ scores at 12 weeks | MD=0.09 (0.00 to 0.18) | NA |
| Hospitalisation§§ | ||||
| Bangladesh49†† | cNRCT | For diarrhoea, all ages | % diff=29%; p<0.01 | 0.38 (0.34 to 0.41) |
| DR52 | cNRCT | During first 2 years of life | AOR=1.09 (0.70 to 1.68) | 1.07 (0.77 to 1.49) |
| India48 | cRCT | During infancy** | ARR=0.67 (0.51 to 0.88) | 0.65 (0.46 to 0.91) |
| SA39 | cRCT | For infant diarrhoea at 12 weeks | RR=1.28 (0.75 to 2.19) | 1.26 (0.67 to 2.39) |
| Access to effective¶¶ treatment | ||||
| DR52 | cNRCT | Diarrhoea, children under two | AOR=3.86 (1.14 to 13.02) | 1.29 (0.79 to 2.12) |
| India48†† | cRCT | Infant** diarrhoea | ARR=1.22 (1.06 to 1.42) | 1.25 (1.11 to 1.41) |
| India48†† | cRCT | Infant** pneumonia | ARR=1.44 (1.00 to 2.08) | 1.24 (0.71 to 2.14) |
| Access to prompt*** treatment | ||||
| India48†† | cRCT | Infant** diarrhoea | ARR=0.99 (0.89 to 1.10) | 1.00 (0.88 to 1.14) |
| India48†† | cRCT | Infant** pneumonia | ARR=1.10 (0.96 to 1.25) | 1.01 (0.84 to 1.22) |
| Mali42†† | BA | Childhood malaria | PR=1.89; p=0.0195 | 1.89 (1.18 to 3.05) |
| Mali43†† | BA | Childhood malaria | AOR=3.20 (1.75 to 5.85) | 2.39 (1.49 to 3.83) |
*The study design reported is the nature of the comparative data in this review.
†Neonatal period is 0–27 days, infant period is 0–11 months and childhood is under 5 years of age, unless otherwise indicated.
‡The BA studies42 43 50 reported each annual time point compared with baseline; here we present effect estimates comparing end-line to baseline.
§For CBA, cRCT and cNRCT study designs, risks were calculated and compared for the postintervention period between intervention and control groups; for BA designs, intervention risk was calculated at end-line and control risk at baseline. Risk ratios and 95% CIs are adjusted for clustering.
¶For the Dominican Republic,52 India,48 Mali42 43 and South Africa39 studies, prevalence based on mother’s reporting of condition during 2 weeks period preceding the interview; for the Senegal45 study, prevalence measured at each time point by positive rapid diagnostic test of symptomatic community members.
**The India48 study also reported effects of similar magnitude at 6 months of age; results not shown. Study found a reduction in neonatal morbidity: danger signs (ARR=0.82; 95% CIs: 0.67 to 0.99) and infection (ARR=0.91; 95% CIs: 0.71 to 1.17), and an increase in access to care for neonates: treatment by appropriate provider for danger signs (ARR=1.76; 95% CIs: 1.36 to 2.24), prompt treatment for danger signs (ARR=1.14; 95% CIs: 1.10 to 1.18), treatment by appropriate provider for infections (ARR=4.86; 95% CIs: 3.80 to 6.21) and prompt treatment for infections (ARR=1.97; 95% CIs: 1.71 to 2.27).
††Study primary outcome(s).
‡‡Based on anthropometric measures for all studies.
§§Measure based on mother’s recall for Dominican Republic52 (last 12 months), India48 (last 3 months) and South Africa39 (recall period not specified) studies; for the Bangladesh49 study, measure based on hospital records. CHWs in the Dominican Republic52 and South Africa39 studies did not provide doorstep treatment but referred all cases detected; CHWs in the Bangladesh49 and India48 studies provided doorstep treatment and referral.
¶¶Defined for the Dominican Republic52 study as oral rehydration for childhood diarrhoea, and for the India48 study as treatment from an appropriate provider, which included physicians in government and private facilities, auxiliary nurse midwife, Anganwadi worker (CHW) or ASHA.48
***Defined as treatment within 24 hours of symptom onset for all studies.
AOR, adjusted OR; ARR, adjusted risk ratio; ASHA, accredited social health activists; BA, before–after; BAZ, Body Mass Index-for-age; CBA, controlled before–after; CHW, community health worker; cNRCT, cluster non-randomised controlled trial; cRCT, cluster randomised controlled trial; LAZ, length-for-age; MD, mean difference; NA, not applicable; RR, risk ratio; WAZ, weight-for-age; WLZ, weight-for-length.