Table 8 Cause-specific mortality effect and GRADE of the estimates for obstetric care packages on intrapartum-related neonatal deaths
Effect of Comprehensive Emergency Obstetric Care Cause specific mortality to act on: Intrapartum related neonatal deaths Quality of input evidence: Very Low – effect estimates derived from Delphi panel consensus Low quality supporting evidence (8 observational, 1 quasi-experimental) GRADE recommendation Strong, based on clear biological mechanism Cause specific effect and range: Reduction in intrapartum related neonatal deaths: 85%; IQR 67.5-87.5% Limitations of the evidence: Evidence without cause-specific mortality effect, and with varying content of packages and varying contexts for evaluation. Only one quasi experimental design study identified |
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Effect of Basic Emergency Obstetric Care Cause specific mortality to act on: Intrapartum related neonatal deaths Quality of input evidence: Very Low – effect estimates derived from Delphi panel consensus No studies identified specifically of BEmOC with perinatal health outcomes reported GRADE recommendation Strong based on clear biological mechanism Cause specific effect and range: Reduction in intrapartum related neonatal deaths: 40%; IQR 40-52.5% Limitations of the evidence: No evidence available regarding effect of this specific package, even from observational designs. |
Effect of Skilled Childbirth Care Cause specific mortality to act on: Intrapartum related neonatal deaths Quality of input evidence: Very low – effect estimates derived from Delphi panel consensus Low quality supporting evidence (2 Quasi-experimental, 8 observational) GRADE recommendation Strong Cause specific effect and range: Reduction in intrapartum related neonatal deaths: 25%; IQR 15-30% Limitations of the evidence: Single study with cause-specific mortality effect. For the studies identified the content of the packages tested and the contexts for evaluation and evaluation designs were variable |
Effect of Trained Traditional Birth Attendants Quality of input evidence: Low quality supporting evidence (3 cRCT, 1 quasi-experimental, 5 observational) GRADE recommendation Conditional, dependent on local context and health system Cause specific effect and range: Not estimated for LiST since GRADE recommendation is conditional Limitations of the evidence: Supporting evidence without cause-specific mortality effect, and with varying content of packages and varying contexts for evaluation. 5 studies primarily of TBA training in neonatal resuscitation that is NOT included as part of the estimate for childbirth care package |