Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada.
J Glob Health. 2023 Dec 27;13:04168. doi: 10.7189/jogh.13.04168.
Evidence on the effectiveness of youth-led interventions for improving maternal-neonatal health and well-being of women and gender diverse childbearing people in low-income and middle-income countries (LMICs) is incomplete. We aimed to summarise the evidence on whether community level youth-led interventions can improve maternal and neonatal outcomes in LMICs.
We included experimental studies of youth-led interventions versus no intervention, standard care, or another intervention. Participants were women and gender diverse childbearing people during antepartum, intrapartum, and postpartum periods. MEDLINE, Embase, CINAHL, Global Health, Web of Science, and Cochrane Library, and grey literature were searched to January 2023. All interventions addressing and targeting maternal-neonatal health and well-being that were youth-led and community level were included. Primary outcomes of interest were maternal death and neonatal death. We excluded based on population, intervention, comparison, and outcome (PICO) and design. Two reviewers independently extracted key information from each included study and assessed risk of bias. Random-effects meta-analysis was performed where there were sufficient data. The certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). A narrative synthesis was done for results that could not be pooled.
Of the 8054 records retrieved, four trials (21 813 enrolled participants) met the inclusion criteria. The Cooperative for Assistance and Relieve Everywhere, Inc. (CARE) Community Score Card intervention compared to standard reproductive health services control did not significantly improve Antenatal Care coverage (difference-in-differences estimate β = 0.04; 95% confidence interval (CI) = -0.11, 0.18, P = 0.610; one study, low certainty of evidence). The multi-component social mobilisation interventions compared to standard of care had no effect on adolescent/youth pregnancy (adjusted odds ratio estimate = 1.08; 95% CI = 0.87, 1.33; three studies; low certainty of evidence).
Youth-led interventions in LMICs did not show a significant improvement in maternal outcomes. More studies are required to make more precise conclusions.
PROSPERO: CRD42021288798.
关于青年主导的干预措施在改善低收入和中等收入国家（LMICs）产妇-新生儿健康和女性及性别多样化的生育人群福祉方面的有效性的证据尚不完整。我们旨在总结社区层面的青年主导的干预措施是否可以改善 LMICs 中的产妇和新生儿结局的证据。
我们纳入了青年主导的干预措施与无干预、标准护理或其他干预措施的对照实验研究。参与者为产前、产时和产后期间的女性及性别多样化的生育人群。我们检索了 MEDLINE、Embase、CINAHL、全球卫生、Web of Science 和 Cochrane 图书馆以及灰色文献，检索时间截至 2023 年 1 月。所有针对产妇-新生儿健康和福祉并由青年主导和社区层面实施的干预措施均被纳入。主要结局指标为产妇死亡和新生儿死亡。我们根据人群、干预措施、比较和结局（PICO）和设计进行了排除。两名评审员独立从每个纳入研究中提取关键信息，并评估了偏倚风险。如果有足够的数据，我们将进行随机效应荟萃分析。使用 Grading of Recommendations, Assessment, Development and Evaluation（GRADE）评估证据的确定性。对于无法进行汇总的结果，我们进行了叙述性综合。
在检索到的 8054 条记录中，有四项试验（纳入 21813 名参与者）符合纳入标准。与标准生殖健康服务对照相比，互助协会（CARE）社区记分卡干预并没有显著改善产前保健覆盖率（差异-差异估计β=0.04；95%置信区间[CI]为-0.11，0.18，P=0.610；一项研究，低确定性证据）。多组分社会动员干预措施与标准护理相比，对青少年/青年怀孕没有影响（调整后的优势比估计值=1.08；95%CI为0.87，1.33；三项研究；低确定性证据）。
LMICs 中的青年主导的干预措施并没有显示出产妇结局的显著改善。需要更多的研究来得出更精确的结论。
PROSPERO：CRD42021288798。
