Intervention effects on mortality outcomes
| Country | Design* | Reported measure of effect (95% CIs)† | Calculation of risk‡ | Calculated RR§ |
| Neonatal mortality | ||||
| India46¶ | CBA | % diff=62.2%; p<0.001 | I: 25/979 C: 66/1108 | 0.43 (0.27, 0.67) |
| India47¶ | cRCT | AHR=0.91 (0.80 to 1.03) | I: 1244/29667 C: 1326/30813 | 0.97 (0.71, 1.33) |
| SA39 | cRCT | RR=1.07 (0.69 to 1.63) | I: 20/1821 C: 22/2136 | 1.07 (0.58, 1.95) |
| Infant mortality | ||||
| India46 | CBA | % diff=45.7%; p<0.001 | I: 38/979 C: 83/1108 | 0.52 (0.36, 0.75) |
| India47¶ | cRCT | AHR=0.89 (0.78 to 1.00) | I: 1925/29667 C: 2136/30813 | 0.94 (0.73, 1.20) |
| Nepal50 | BA | 0 to 6 days: RR=0.80 (0.59, 1.10) 0.25 to 5 months: RR=0.74 (0.58, 0.94) 6 to 11 months: RR=0.36 (0.24, 0.56) | I: 236/13406 C: 199/6684 | 0.60 (0.37, 0.96) |
| Pakistan51¶ | cNRCT | % diff=21%; ‘not significant’ | I: 108/4665 C: 31/1194 | 0.87 (0.52, 1.46) |
| Child mortality | ||||
| Mali42 | BA | HR=0.10; p<0.0001 | I: 29/1390 C: 38/316 | 0.17 (0.11, 0.28) |
| Mali43 | BA | HR=0.039 (0.013 to 0.116) | I: 5/1023 C: 39/330 | 0.04 (0.02, 0.10) |
| Nepal50¶ | BA | RR=0.72 (0.63 to 0.82) | I: 409/13406 C: 301/6684 | 0.67 (0.46, 0.98) |
| Pakistan51¶ | cNRCT | % diff=26%; p<0.001 | I: 149/4665 C: 47/1194 | 0.80 (0.52, 1.22) |
Neonatal period reported is 0–27 days. Infant period is 0–11 months. Child mortality period is 0–59 months. India46 also reports mortality separately for early (0–6 days) neonates: % diff=57.3%; p<0.001; calculated RR=0.45, and late (7–27 days) neonates: % diff=51.6%; calculated RR=0.31. Study also found a reduction in perinatal mortality % diff=71.0%; p<0.001. A 2005 summary of this field trial reports that reductions in neonatal mortality and infant mortality reached 70% (95% CIs: 59, 81%) and 57% (95% CIs: 46, 68%), respectively, after 8 years postintervention.65 India47 also reports mortality for neonates after the first day of life: AHR=0.86 (0.79 to 0.95); calculated RR=0.93. Study also found a reduction in perinatal (AHR=0.89; 95% CIs: 0.78 to 1.00) and postneonatal (AHR=0.76; 95% CIs: 0.67 to 0.85) mortality. Nepal50 reports no overall infant mortality, only by infant age brackets; denominators for calculated infant and childhood risks are based on study report that initial census registered66 84 children (control) and an additional 6722 were born during the study for a total of 13 406 children available (intervention). Pakistan51 compares mortality rates between intervention and control periods for the 1985–1986 postintervention period; calculated risks are for 1985 only for which the study reports number of children per arm. Nepal50 and Pakistan51 also report disease-specific mortality rates; results not shown. The South Africa39 study found no effect (RR=0.97; 95% CIs: 0.67 to 1.40) on the primary joint mortality–morbidity outcome: HIV-free infant survival at 12 weeks among HIV-positive mothers.
*The study design reported is the nature of the comparative data, not necessarily the design as described by study authors.
†The before–after (BA) studies42 43 50 reported each annual time point compared with baseline; here we present end-line to baseline risk ratios.
‡Reviewer (CW) calculated risk of death for intervention (I) and comparison (C) groups by taking number of events over number of live births (or, if unavailable, over population). For CBA, cRCT and cNRCT study designs, risks were calculated and compared (ie, calculated risk ratio) for the postintervention period between intervention and control groups; for BA study designs, intervention risk was calculated at end-line and control risk at baseline.
§Risk ratios and 95% CIs are adjusted for clustering.
¶Study primary outcome(s).
AHR, adjusted HR; BA, before–after; CBA, controlled before–after; cNRCT, cluster non-randomised controlled trial; cRCT, cluster randomised controlled trial; RR, risk ratio.