The effect of demand-side financial incentives for increasing linkage into HIV treatment and voluntary medical male circumcision: A systematic review and meta-analysis of randomised controlled trials in low- and middle-income countries

Abstract No consensus exists regarding which are the most effective mechanisms to promote household action on climate change. We present a meta-analysis of randomised controlled trials comprising 3,092,678 observations, which estimates the effects of behavioural interventions holding other factors constant. Here we show that behavioural interventions promote climate change mitigation to a very small degree while the intervention lasts (d = −0.093 95% CI −0.160, −0.055), with no evidence of sustained positive effects once the intervention ends. With the exception of recycling, most household mitigation behaviours show a low behavioural plasticity. The intervention with the highest average effect size is choice architecture (nudges) but this strategy has been tested in a limited number of behaviours. Our results do not imply behavioural interventions are less effective than alternative strategies such as financial incentives or regulations, nor exclude the possibility that behavioural interventions could have stronger effects when used in combination with alternative strategies.

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Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2014-005983 ◽

2014 ◽

Vol 4 (10) ◽

pp. e005983 ◽

Cited By ~ 61

Author(s):

Gbenga Ogedegbe ◽

Joyce Gyamfi ◽

Jacob Plange-Rhule ◽

Alisa Surkis ◽

Diana Margot Rosenthal ◽

...

Keyword(s):

Systematic Review ◽

Risk Reduction ◽

Low Income ◽

Randomised Controlled Trials ◽

Blood Pressure Reduction ◽

Task Shifting ◽

Controlled Trials ◽

Middle Income ◽

Middle Income Countries ◽

Randomised Controlled

ObjectiveTo evaluate evidence from published randomised controlled trials (RCTs) for the use of task-shifting strategies for cardiovascular disease (CVD) risk reduction in low-income and middle-income countries (LMICs).DesignSystematic review of RCTs that utilised a task-shifting strategy in the management of CVD in LMICs.Data SourcesWe searched the following databases for relevant RCTs: PubMed from the 1940s, EMBASE from 1974, Global Health from 1910, Ovid Health Star from 1966, Web of Knowledge from 1900, Scopus from 1823, CINAHL from 1937 and RCTs from ClinicalTrials.gov.Eligibility criteria for selecting studiesWe focused on RCTs published in English, but without publication year. We included RCTs in which the intervention used task shifting (non-physician healthcare workers involved in prescribing of medications, treatment and/or medical testing) and non-physician healthcare providers in the management of CV risk factors and diseases (hypertension, diabetes, hyperlipidaemia, stroke, coronary artery disease or heart failure), as well as RCTs that were conducted in LMICs. We excluded studies that are not RCTs.ResultsOf the 2771 articles identified, only three met the predefined criteria. All three trials were conducted in practice-based settings among patients with hypertension (2 studies) and diabetes (1 study), with one study also incorporating home visits. The duration of the studies ranged from 3 to 12 months, and the task-shifting strategies included provision of medication prescriptions by nurses, community health workers and pharmacists and telephone follow-up posthospital discharge. Both hypertension studies reported a significant mean blood pressure reduction (2/1 mm Hg and 30/15 mm Hg), and the diabetes trial reported a reduction in the glycated haemoglobin levels of 1.87%.ConclusionsThere is a dearth of evidence on the implementation of task-shifting strategies to reduce the burden of CVD in LMICs. Effective task-shifting interventions targeted at reducing the global CVD epidemic in LMICs are urgently needed.

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The Landscape of Randomised Controlled Trials of Therapies in Breast Cancer in Low and Middle Income Countries

International Journal of Breast Cancer ◽

10.1155/2017/4259704 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Katharine Lynch-Kelly ◽

Matthew Singer ◽

Norman R. Williams

Keyword(s):

Breast Cancer ◽

Cancer Research ◽

Randomised Controlled Trials ◽

Breast Cancer Research ◽

Sub Saharan Africa ◽

Controlled Trials ◽

Middle Income ◽

Middle Income Countries ◽

Sub Saharan ◽

Randomised Controlled

Objectives. The objectives of this study were to identify the randomised controlled trials in breast cancer occurring in low and middle income countries (LMICs) generally and within Sub-Saharan Africa specifically, to describe the current status and identify opportunities for further research in these areas. Materials and Methods. Data for this study were obtained from ClinicalTrials.gov. The search term “Breast Cancer Research” was used, and relevant information extracted and analysed. Results. 2414 trials were identified, of which 1099 were eligible for inclusion. 69 of these trials occurred in LMICs. Of the 52 LMICs globally, 30% were participating in breast cancer research. Of the 17 LMICs in Africa, 77% are situated in Sub-Saharan Africa; 23% were participating in breast cancer research, which accounted for 9% of total Sub-Saharan African studies. Conclusion. This study provides current evidence for the need for breast cancer research in LMICs globally and within Sub-Saharan Africa. Within LMIC regions where research is active, the type and numbers of studies are unevenly distributed. High quality research within such areas should be encouraged as the results may have both local and global applications, particularly in the provision of affordable health care.

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Effective community-based interventions to improve exclusive breast feeding at four to six months in low- and low–middle-income countries: a systematic review of randomised controlled trials

Midwifery ◽

10.1016/j.midw.2010.03.011 ◽

2011 ◽

Vol 27 (4) ◽

pp. 497-502 ◽

Cited By ~ 18

Author(s):

Jennifer Hall

Keyword(s):

Systematic Review ◽

Randomised Controlled Trials ◽

Controlled Trials ◽

Community Based Interventions ◽

Community Based ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Effective Community ◽

Randomised Controlled

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The impact of psychosocial interventions on neonatal and maternal mortality in LMICs: a meta-analysis of randomised controlled trials

10.21203/rs.2.20082/v1 ◽

2020 ◽

Author(s):

Elena M. C. Riedel ◽

David T. Turner ◽

Clara Miguel Sanz ◽

Loulou Hassan Kobeissi ◽

Eirini Karyotaki ◽

...

Keyword(s):

Maternal Mortality ◽

Neonatal Mortality ◽

Randomised Controlled Trials ◽

Psychosocial Interventions ◽

Risk Of Bias ◽

Controlled Trials ◽

Middle Income ◽

Middle Income Countries ◽

Randomised Controlled ◽

Low And Middle Income

Abstract Background Despite progress in medical and skilled delivery care worldwide, neonatal and maternal mortality is still a major public health problem in resource-limited settings.Objective To determine whether psychosocial interventions (PSI) can reduce neonatal and maternal mortality in low-and middle-income countries, and which approaches are most promising.Methods Randomised controlled trials comparing a PSI with a control condition were identified through systematic searches in seven databases. Effects were pooled as risk ratios in random-effects meta-analyses. Risk of bias was assessed using the Cochrane risk of bias tool, and publication bias was estimated. Sensitivity analyses were conducted to investigate sources of heterogeneity.ResultsOf 22 eligible RCTs (20 cluster randomised trials), the outcomes of 21 were synthesized for the outcome of neonatal mortality and 14 for maternal mortality. PSIs effectively reduced the risk of neonatal mortality by about 15% (RR 0.85, 95% CI 0.78-0.94). The risk of maternal death was reduced by almost 21% (RR 0.79, 95% CI 0.68-0.93) with low levels of heterogeneity. There was low to medium risk of bias and no indication for substantial publication bias.Conclusions Results suggest that PSIs, mainly multi-method and group-based approaches, have the potential to substantially decrease the risk of maternal and neonatal death in low- and middle-income countries. The results of the latter outcome are marked by high heterogeneity and thus to be taken with caution.

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Does Influenza Vaccination during Pregnancy Have Effects on Non-Influenza Infectious Morbidity? A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Vaccines ◽

10.3390/vaccines9121452 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1452

Author(s):

Katrine Pedersbæk Hansen ◽

Christine Stabell Benn ◽

Thomas Aamand ◽

Martin Buus ◽

Isaquel da Silva ◽

...

Keyword(s):

Adverse Events ◽

Pregnant Women ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Middle Income ◽

Live Vaccines ◽

All Cause Mortality ◽

Randomised Controlled ◽

Meta Analyses

The recommendation to provide inactivated influenza vaccine (IIV) to pregnant women is based on observed protection against influenza-related morbidity in mother and infant. Non-live vaccines may have non-specific effects (NSEs), increasing the risk of non-targeted infections in females. We reviewed the evidence from available randomised controlled trials (RCTs) of IIV to pregnant women, to assess whether IIV may have NSEs. Four RCTs, all conducted in low- and middle-income settings, were identified. We extracted information on all-cause and infectious mortality and adverse events in women and their infants. We conducted meta-analyses providing risk ratios (RR). The meta-analysis for maternal all-cause mortality provided a RR of 1.48 (95% CI = 0.52–4.16). The estimates for miscarriage/stillbirth and infant all-cause mortality up to 6 months of age were 1.06 (0.78–1.44) and 1.11 (0.87–1.41), respectively. IIV was associated with a higher risk of non-influenza infectious adverse events, with meta-estimates of 2.01 (1.15–3.50) in women and 1.36 (1.12–1.67) in infants up to 6 months of age. Thus, following a pattern seen for other non-live vaccines, IIV was associated with a higher risk of non-influenza infectious adverse events. To ensure that scarce resources are used well, and no harm is inflicted, further RCTs are warranted.

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