Center for Evaluation and Development

The World Health Organization (WHO) Safe Childbirth Checklist (SCC) has been adapted and implemented in at least 35 countries. Consistently, the SCC has shown increased adherence to practices, but there are mixed results regarding its association with health outcomes in different settings. To examine the association of SCC implementation with mortality, accounting for variations in evidence-based practices (EBP) adherence. In this meta-analysis, data were pooled from 3 cluster randomized trials of the SCC (January 1, 2014, to December 31, 2017). Intention to treat (ITT) and a complier average causal effect analysis (CACE) on EBPs and perinatal mortality were estimated via a generalized linear model. The primary facilities were in Uttar Pradesh, India; basic emergency obstetric facilities were in Aceh, Indonesia; and primary and secondary health centers were in Khyber Pakhtunkhwa, Pakistan. In India, the 8-month SCC intervention involved facility engagement, a launch event, and 8 months of tapered coaching. In Indonesia, the 6-month SCC intervention included 11 coaching visits. In Pakistan, the 12-month SCC intervention included light touch external monitoring, skills training, and supplies assessment. Primary outcomes were stillbirth and perinatal and early neonatal mortality. Secondary outcomes were adherence to 15 EBPs, facility supply availability, and safety culture perceptions. Pooled data included 169 511 births, supply assessments from 163 facilities, and 6298 observed deliveries for EBPs and health workers' perceptions on safety culture. Mortality did not differ in the full sample; however, during months when EBP observations were conducted, stillbirth rates in the intervention facilities were lower by 9.8 per 1000 births (95% CI, -18.5 to -1.1; P = .03; q = .05) in the ITT analysis and 14.5 per 1000 births (95% CI, -27.2 to -1.7; P = .03; q = .05) in the CACE analysis compared with control facilities. EBP adherence was higher by 3.6 practices (95% CI, 3.3 to 4.1; P < .001; q = .001) in the ITT analysis and 6.0 practices (95% CI, 5.3 to 6.8; P < .001; q = .001) in the CACE analysis in intervention facilities. In this meta-analysis, SCC use in lower-middle-income settings was associated with increased EBP adherence and lower rates of stillbirths when EBPs were directly observed. Further research is needed to identify additional factors to optimize SCC's potential impact on maternal and newborn safety outcomes.

Abstract Background Clinical trials provide much of the evidence that guides decision making about treatment and care but are often complicated to deliver. Trials can be thought of as complex systems with interacting individuals, as such behavioural science is a useful lens to investigate how trial processes may be improved. To guide selection of an appropriate behavioural theory, model, or framework to further enhance trial processes, we sought to map their past application within the design, conduct, analysis and reporting of clinical trials. Methods A systematic review to investigate scope of trials methods research that had utilised a behavioural theory, model, or framework was conducted through a database search and citation analysis. Publications investigating any part of the trial lifecycle (from design to reporting) through a behavioural lens were included. Results A total of 96 studies were included. A majority of these (n = 93, 97%) investigated trial conduct processes, such as recruitment and retention. Three behavioural theories, models or frameworks, the Theory of Planned Behaviour (n = 23, 24%), Social Cognitive Theory (n = 12, 13%), and the Theoretical Domains Framework (n = 30, 31%), accounted for more than two-thirds of those utilised. When compared to key stages of the Knowledge to Action cycle, approaches reported in included studies were most often utilised to “Identify a problem” within trials (n = 40, 42%). Conclusion A wide variety of behavioural approaches to study trial conduct were identified. However, the trial processes studied clustered within trial recruitment and largely used a few select approaches. Future research should assess whether these approaches are fit for purpose, as well as prioritising other trial areas for methods research.

Abstract This article describes the approach for an evidence review that combines two different evidence gap maps into one learning exercise on transformational change. The review assesses the evidence in two sectors where there has been demonstrable progress in terms of scale, depth and permanence of change: in energy and in behavioural change in public health. The review uses causal evidence to assess how lessons about transformational change in these two sectors may inform climate change mitigation and adaptation investments in low- and middle-income countries. The evidence gap maps will inform the scope of systematic reviews and meta-analyses.

Early-childhood interventions are important for poverty reduction but difficult to target. We study two interventions in rural India for children below age 2 that are simple and easy to scale: a durable device for iron fortification at home and caregiver training in dialogic reading. Outcomes were measured blinded. When delivered together, the interventions improved receptive language skills of children who were not anemic at baseline, suggesting that health endowment complements parental investments in the production of human capital. The dialogic reading intervention further shows positive spillovers on untreated children. Overall, shorter-lived interventions are potentially effective in healthier populations.

Abstract In Africa, entrepreneurship remains predominantly informal, but the rapid spread of mobile phone and Internet use is often viewed as an opportunity to boost the productivity and output of informal firms. Yet little is known on how informal entrepreneurs use these technologies for their business. The purpose of this paper is to open the black box of ‘mobile usage’ and investigate its effects on the performance of informal micro and small enterprises. To do so, we develop an original conceptual framework of mobile usage and apply a three‐step empirical approach based on a unique dataset of informal firms in Dakar. The first step allows us to identify rich ‘mobile usage’ measures that examine the different economic functions supported by mobile phones (coordination, finance and management) and the multiple dimensions of use (range and intensity). The second step identifies four user profiles with specific forms of appropriation: disconnected entrepreneurs, networkers, Internet explorers and digital entrepreneurs. The third step uses a stochastic frontier approach to investigate whether these profiles increase the economic efficiency of informal firms. Our findings suggest that while the most advanced uses of mobile phones have an incremental impact on sales efficiency, the potential for improvement remains limited. Only networkers' coordination uses show a significant impact on value added and profit, while the ways in which Internet explorers and digital entrepreneurs use a mobile phone have only a limited impact.

Objectives: To investigate the reach and impact of “Infomails”, email summaries of Cochrane reviews in German, regularly disseminated by Cochrane Public Health Europe (CPHE) to stakeholders in Austria, Germany and Switzerland.Methods: We analysed email campaign reports from 15 Infomails delivered until November 2020. Furthermore, we invited all previous Infomail recipients to participate in an online survey on the impact and perceptions regarding our Infomails in November 2020. We analysed the results using descriptive statistics.Results: The Infomails’ open rate ranged from 10.9% to 39.3% (median 26.0%), and the median click rate on the embedded links was 28.0% (range 8.6–53.8%), highest for nutrition and prevention topics. Out of 1259 recipients, 267 (21.2%) completed our survey. Infomails were most used in discussions, writing reports or statements, for policy or strategy development or programme or guideline development. Persons who remembered receiving Infomails rated them as useful, comprehensible or informative.Conclusion: Infomails summarising recent Cochrane reviews were considered useful for the daily work of public health stakeholders in German-speaking countries. Regular targeted messaging may increase the perceived usefulness.

Trust is considered an important factor for successful collective action in groups of smallholder farmers. A prime example is collective commercialization of agricultural produce through producer organizations. While previous research has focused on trust as an exogenous determinant of participation in groups, this article tests whether trust within existing groups can be improved using a training program. We conduct a cluster-randomized controlled trial in rural Senegal to identify the effects of training members and/or leaders with respect to commercialization on intragroup trust. Our design allows identifying both direct treatment effects of having participated in the training and spillover effects on farmers who did not partake. Looking at different measures of trust in leaders’ competence and motives and of trust in members, we find that participating in the training significantly enhances both trust in leaders and trust in members. For trust in leaders, we also find a strong spillover effect. Our findings suggest that relatively soft and noncostly interventions such as group training appear to positively affect trust within producer organizations.