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Table 2 Quality assessment of studies of community case management for the treatment of pneumonia

From: Effect of community based interventions on childhood diarrhea and pneumonia: uptake of treatment modalities and impact on mortality

 

Quality Assessment

Summary of Findings

 

Directness

No of events

 

No of studies

Design

Limitations

Consistency

Generalizability to population of interest

Generalizability to intervention of interest

Intervention

Control

Relative Risk (95% CI)

ALRI mortality 0–1 months: moderate outcome specific quality of evidence

Four

Concurrent

No Major

3 of 4 studies show benefit

Africa and Asia

3 of 4 studies WHO case management by local health workers

384

686

0.58 (0.44–0.77)

ALRI specific mortality 0–1 year: moderate outcome specific quality of evidence

Six

Concurrent

No major limitations

Heterogeneity from meta-analysis, All studies show benefit

Africa and Asia

4 of 6 studies WHO case management

916

1510

0.59 (0.46–0.75)

Two

Before/After

High ALRI incidence

Heterogeneity from meta-analysis, All studies show benefit

Asia

1 of 2 studies WHO case management

7

34

0.36 (0.16–0.82)

Seven

Concurrent; before/ after

See Above

Heterogeneity from meta-analysis, All studies show benefit

Africa and Asia

See Above

917

1522

0.57 (0.44–0.75)

Nine

Concurrent; before/ after

See Above

Heterogeneity from meta-analysis, All studies show benefit

Africa and Asia

See Above

938

1569

0.58 (0.50– 0.67)

ALRI-specific mortality 1–4 years: low outcome specific quality of evidence

Two

Before/After

High ALRI incidence

Both studies show benefit

Asia

1 of 2 studies WHO case management

10

24

0.51 (0.24–1.07)

ALRI-specific mortality 0-4 years: moderate outcome specific quality of evidence

Eight

Concurrent

No major limitation

Five of eight studies show benefit

Africa and Asia

6 of 8 studies WHO case management

705

948

0.68 [0.53, 0.86]

Six

Before/After

No major limitation

Four of six studies show benefit

Africa and Asia

3 of 5 studies WHO case management

220

271

0.77 [0.54, 1.08]

Ten

Concurrent; before/ after

See Above

Eight of ten studies show benefit

Africa and Asia

See Above

724

986

0.67 [0.51, 0.88]

Eleven

Concurrent; before/ after

See Above

Nine of eleven studies show benefit

Africa and Asia

See Above

744

1032

0.68 [0.53, 0.88]

All cause mortality 0–1months: moderate outcome specific quality of evidence

Five

Concurrent

No major limitation

All studies show benefit

Africa and Asia

4 of 5 studies WHO case management

925

957

0.73 (0.65– 0.82)

All-cause mortality 0–1 year: moderate outcome specific quality of evidence

Six

Concurrent

No Major limitation

All studies show benefit

Africa and Asia

4 of 6 studies WHO case management

2095

2487

0.78 (0.71– 0.85)

Two

Before/After

High ALRI incidence

All studies show benefit

Asia only

1 of 2 studies WHO case management

41

100

0.60 (0.42–0.85)

Seven

Concurrent; before/ after

See above

All studies show benefit

Africa and Asia

See above

2114

2524

0.77 (0.70– 0.85)

Nine

Concurrent; before/ after

See Above

All studies show benefit

Africa and Asia

See above

2230

2703

0.79 (0.72–0.86)

All-cause mortality 1–4 years: low outcome specific quality of evidence

Two

Before/After

High ALRI incidence

Both studies show benefit

Only Asia

1 of 2 studies WHO case management

43

82

0.49 (0.34–0.70)

All-cause mortality 0–4 years: moderate outcome specific quality of evidence

Nine

Concurrent

No major limitation

Six studies show benefit

Africa and Asia

6 of 9 studies WHO case management

3115

4180

0.83 [0.73, 0.95]

Six

Before/After

No major limitation

Four studies show benefit

Africa and Asia

3 of 6 studies WHO case management

1141

1063

0.90 [0.64, 1.26]

Eleven

Concurrent; before/ after

No major limitation

See Above

Africa and Asia

See Above

3113

4401

0.80 [0.77, 0.83]

Twelve

Concurrent; before/ after

No major limitation

See Above

Africa and Asia

See Above

3214

4473

0.80 [0.77, 0.83]