Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: protocol for a multisite hybrid effectiveness-implementation type III trial

Table 1 Published randomized controlled trials with moderate- to high-certainty evidence

Study	Study design	Type of intervention	Overall CS rate in %				Relative effect (95% CI)
			Intervention		Control
			Baseline	Post	Baseline	Post
Lomas [12]	Cluster RCT	Opinion leader education		53.7*		66.8*	Not reported
Lomas [12]		Audit and feedback		69.7*		66.8*	Not reported
Althabe [13]	Cluster RCT	Mandatory second opinion	26.3	24.7	24.6	24.9	ARR −1.9 (−3.8 to −0.1)
Chaillet [14]	Cluster RCT	Audit and feedback	22.5	21.8	23.2	23.5	ARR −1.8 (−3.8 to −0.2)
Chaillet [14]	RCT	Audit and feedback	8.5**	7.6**	8.5**	9.0**	ARR −1.7 (−3.0 to −0.3)
Mansoumi [15]	RCT	Antenatal education program for physiologic childbirth		45.0		43.7	RR 1.03 (0.72 to 1.49)
Bergstrom [16]	RCT	Antenatal education on natural childbirth preparation with training in breathing and relaxation techniques		59.9*		63.0*	RR 0.95 (0.58 to 1.56)
Fraser [17]	RCT	Individualized prenatal education and support program versus written information in pamphlet		21.3		23.7	RR 0.90 (0.74 to 1.11)
Montgomery [18]	RCT	Computer-based decision aids (information program, decision analysis)		48.6*		49.6*	RR 0.98 (0.82 to 1.18)
Shorten [19]	RCT	Decision aid booklet during antenatal care		49.4*		52.2*	Not reported
Bohren [11]	Meta-analysis	Companionship during labor		12.3		15.0	RR 0.75 (0.64 to 0.88)

RCT randomized controlled trial with intervention at the woman’s level; cluster-RCT randomized controlled trial with intervention at the hospital or healthcare provider level
For RCTs, risk ratio (RR) = (mean rate intervention/mean rate control) with 95% confidence intervals
For the meta-analysis of RCTs, the relative effect is the summary risk ratio with 95% confidence intervals
For cluster-RCTs, absolute risk reduction (ARR) = (rate change in the intervention group)—(rate change in the control group) with 95% confidence intervals
*The selected outcome is the elective repeat cesarean section rate among high-risk women (women with previous CS)
**The selected outcome is the overall CS rate among low-risk women (single pregnancy with cephalic presentation without any complication)

ISSN: 1748-5908