Community level youth-led interventions to improve maternal-neonatal outcomes in low- and middle-income countries: A systematic review of randomised trials

Background Evidence on the effectiveness of youth-led interventions for improving maternal-neonatal health and well-being of women and gender diverse childbearing people in low-income and middle-income countries (LMICs) is incomplete. We aimed to summarise the evi-dence on whether community level youth-led interventions can im-prove maternal and neonatal outcomes in LMICs. Methods We included experimental studies of youth-led interven-tions versus no intervention, standard care, or another intervention. Participants were women and gender diverse childbearing people during antepartum, intrapartum, and postpartum periods. MED-LINE, Embase, CINAHL, Global Health, Web of Science, and Co-chrane Library, and grey literature were searched to January 2023. All interventions addressing and targeting maternal-neonatal health and well-being that were youth-led and community level were included. Primary outcomes of interest were maternal death and neonatal death. We excluded based on population, intervention, comparison, and out-come (PICO) and design. Two reviewers independently extracted key information from each included study and assessed risk of bias. Ran-dom-effects meta-analysis was performed where there were sufficient data. The certainty of evidence was assessed using Grading of Rec-ommendations, Assessment, Development and Evaluation (GRADE). A narrative synthesis was done for results that could not be pooled. Results Of the 8054 records retrieved, four trials (21 813 enrolled par-ticipants) met the inclusion criteria. The Cooperative for Assistance and Relieve Everywhere, Inc. (CARE) Community Score Card inter-vention compared to standard reproductive health services control did not significantly improve Antenatal Care coverage (difference-in -dif-ferences estimate beta = 0.04; 95% confidence interval (CI) =-0.11, 0.18, P = 0.610; one study, low certainty of evidence). The multi -compo-nent social mobilisation interventions compared to standard of care had no effect on adolescent/youth pregnancy (adjusted odds ratio es-timate = 1.08; 95% CI = 0.87, 1.33; three studies; low certainty of ev-idence). Conclusions Youth-led interventions in LMICs did not show a signif-icant improvement in maternal outcomes. More studies are required to make more precise conclusions.