Intervention effectiveness to reduce maternal/child mortality
As part of the current CHERG, working groups have been formed to do systematic reviews of effectiveness and efficacy of various maternal and child health interventions. These groups are building on reviews that were done for previous work that appeared in the Lancet Series on Child Survival, Neonatal Survival and Maternal and Child Undernutrition. The reviews of effectiveness in those series, while very good, did not necessarily use a consistent approach to either the reviews of data or in the establishment of best estimates of effectiveness. One purpose of the new review process in CHERG is to ensure that estimates of effectiveness and efficacy for various interventions use comparable methods that will produce comparable outputs which will be published.
A second area of work for CHERG is to investigate the effectiveness of new interventions that were not included in the initial reviews. This could include the effectiveness of new vaccines, such a rotavirus vaccine, or areas that were treated at a more macro level in previous reviews, such as improved sanitation, by refining the estimates of effectiveness to more program-specific interventions. Other areas of work that future reviews of effectiveness will have to address include; 1) the interactions of interventions; estimates of effectiveness of the actual implementation strategy for an intervention; and 3) the cost of interventions and packages of interventions.
Methods and Expected Products
During the two years of the sub-grant, the activities will be focused on analyzing and synthesizing cost data, the indirect effects of interventions on mortality and the interaction of interventions, to ensure that new technologies and program delivery approaches be included in decision-support tools like LiST. Full analysis and specification of how to include these factors within the LiST tool will be made publicly available via the CHERG website and other channels including peer-review.
As part of the review process, activities will include the formation of expert groups to conduct literature reviews and analysis concerning new interventions proposed for inclusion in LiST, as well as to evaluate new data on effectiveness of old interventions to be incorporated into new estimates of effectiveness. There will be several small-group meetings held durig the two-year sub-grant period, with additional teleconferences.
Eisele TP, Larsen DA, Anglewicz PA, Keating J, Yukich J, Bennett A, Hutchinson P, Steketee RW. Malaria prevention in pregnancy, birthweight, and neonatal mortality: a meta-analysis of 32 national cross-sectional datasets in Africa. Lancet Infect Dis. 2012 Sep 17. pii: S1473-3099(12)70222-0. doi: 10.1016/S1473-3099(12)70222-0. [Epub ahead of print]
Eisele TP, Larsen DA, Walker N, Cibulskis RE, Yukich JO, Zikusooka CM, Steketee RW. Estimates of child deaths prevented from malaria prevention scale-up in Africa 2001-2010. Malar J. 2012 Mar 28;11:93.