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  • Despite all the progress made in

    2018-10-23

    Despite all the progress made in the last decade, it is very unlikely that the MDG targets will be met in many LMICs, where 99% of global deaths occur (You et al., 2013). In countries with a high burden of neonatal and child mortality, a variety of interventions could substantially reduce deaths and improve maternal and perinatal outcomes. Interventions and care primarily employed during different periods from antenatal to the later childhood hop over to here can facilitate reductions in neonatal and later mortality. However, a major obstacle in meeting the proposed reduction is that most neonatal and child health programs do not reach to those who need it the most. Therefore, effective interventions and care-based strategies need to be widely deployed to all and be delivered across the continuum of reproductive, maternal, neonatal and child health (RMNCH) care.
    Methodology In this overview of reviews, we have included all published Cochrane and the most recent (most latest on the given subject) other systematic reviews of randomized, non-randomized controlled trials of interventions and observational studies aiming to prevent perinatal (stillbirths+early neonatal mortality) or neonatal or child mortality (or stillbirths where either of these were not reported). We included interventions considered for improving neonatal and child survival and provided during pre-pregnancy, antenatal, childbirth and postnatal periods to mothers or the infant or child included in a set of 61 RMNCH interventions reported as essential interventions for reproductive, maternal, newborn and child health by the World Health Organization (WHO) (Panel 1) (Pmnch, 2011). We considered reviews that included women of reproductive age, including pregnant women at any stage of gestation, their newborns and children up to five years of age. This overview considered reviews on interventions which were compared against no placebo or treatment or control group (unless otherwise indicated). All available recent non-Cochrane and updated or most recent Cochrane systematic reviews were identified from the Cochrane Library and PubMed using the search strategy devised for each intervention separately during Nov 2012 to Jan 2013 (Supplementary Table 1). The search terms were limited to title, abstract, or keywords. The methodology for data collection and analysis is based on the Cochrane Handbook of Systematic Reviews of Interventions (Higgins and Green, 2011). The outcomes of interest for deoxyribose overview of reviews were perinatal mortality, neonatal mortality, infant mortality and under-five mortality reported as primary or secondary outcomes in included reviews. The protocol for this overview is registered with PROSPERO 2014: CRD42014007091 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007091#.U75a1RCLMiw). Two review authors (ZSL and PM) independently assessed the inclusion of all the potential systematic reviews and extracted information using a predefined form (intervention, comparison, mortality outcome, type of studies included — Characteristics of included reviews Supplementary Table 2). Any disagreement was resolved through discussion or, where required, we consulted a third person. We addressed two different quality assessments in this overview: the quality of evidence in the included reviews (Table 1) using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach (Guyatt et al., 2008; Oxman and Group, 2004) and the methodological quality of the systematic reviews using the ‘assessment of multiple systematic reviews’ (AMSTAR) measurement tool (Shea et al., 2007) (Supplementary Table 3). We did not update individual reviews. Where reviews did not prepare and report mortality outcomes using GRADE-pro software (Brozek et al., 2008), we formulated ‘summary of findings’ tables. The following criteria were taken into account to grade the evidence: study limitations (risk of bias for the outcome of interest), consistency of effect, imprecision, indirectness, and publication bias. We summarised the main results of the included reviews into following categories.