Community-Based Interventions for Reducing Neonatal Mortality in Low-Resource Settings: A Scoping Review and Evidence Gap Map

Community-Based Interventions for Reducing Neonatal Mortality in Low-Resource Settings: A Scoping Review and Evidence Gap Map | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Community-Based Interventions for Reducing Neonatal Mortality in Low-Resource Settings: A Scoping Review and Evidence Gap Map Abigail Boatemaa, Gabriel Osei Forkuo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9017125/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Neonatal mortality disproportionately affects sub-Saharan Africa and South Asia, where facility-based care alone often misses vulnerable populations. Consequently, community-based interventions are widely advocated. However, the breadth, quality, and certainty of the supporting evidence lack comprehensive mapping. This study maps the evidence landscape for community-based neonatal mortality interventions to identify critical research gaps. Methods Following JBI scoping review and EPPI-Centre Evidence Gap Map standards, we searched OpenAlex, CrossRef, and Semantic Scholar via Python 3.12, supplemented by grey literature. A purposive, citation-informed corpus of 200 high-impact studies was selected. Quality was assessed using Cochrane RoB 2 (11 RCTs), ROBINS-I (17 non-randomised studies), AMSTAR-2 (4 systematic reviews), CASP (2 qualitative), and a Quality Indicators Checklist (166 non-evaluative studies). High heterogeneity precluded meta-analysis; data were narratively synthesized and evidence certainty assessed using GRADE criteria. Results Community health worker (CHW) programmes, participatory women’s groups, and essential newborn care (ENC) were evaluated most frequently. Methodological quality was mixed: all 11 RCTs showed "some concerns" (RoB 2) and all 17 non-randomised studies indicated "moderate risk" (ROBINS-I). Consequently, GRADE certainty for RCT-derived outcomes was very low to moderate, downgraded primarily for indirectness, inconsistency, and imprecision. Narratively, women's groups, CHW home visits, and ENC most consistently reduced mortality. Geographically, within this highly cited corpus, West Africa was substantially underrepresented relative to its severe disease burden. Conclusions Moderate-certainty evidence, predominantly from South Asian cluster RCTs, supports the mortality-reducing benefits of specific community packages. However, this geographically skewed and heterogeneous evidence base precludes strong causal conclusions for West African settings, though regional literature may exist outside the queried databases. This review highlights profound gaps in highly cited, rigorous evidence for high-burden regions, emphasizing the need for equitable research investment and the application of advanced causal and adaptive study designs (e.g., quasi-experiments, micro-randomized trials) to guide local policy. Nursing Preventive Medicine Pediatrics Epidemiology antenatal care evidence synthesis essential newborn care GRADE framework perinatal survival skilled birth attendance Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9017125","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":599792379,"identity":"12d892e9-4154-4ca9-a195-91dd7182ce3c","order_by":0,"name":"Abigail Boatemaa","email":"","orcid":"https://orcid.org/0009-0004-5919-4361","institution":"University of Bradford","correspondingAuthor":false,"prefix":"","firstName":"Abigail","middleName":"","lastName":"Boatemaa","suffix":""},{"id":599792134,"identity":"f0de2d3f-101e-4936-9092-15fe658899a3","order_by":1,"name":"Gabriel Osei Forkuo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYFACHgaGBAYLBvYGBmYgz4YBSLERo0WCgecAWEsaUAszEVoYEFoOAzEBLfLuZ499eFAB1MLe+9iYp+J84nZ2/mOPeRjuyeHSYngmL3lGwhmgFp7jxsk8Z24n7mxmZjfmYSg2xqmlIceYIbFNgsFeIo35MG/b7cQNh5nZJGcwJCQ24NLS/wao5R/QFoiWc4S1yEuAbGmAaEnmbTsA1iLxAY8WA4l3yQwJxyR4eHiOMRvOOZNsDNRibvDBIAGnX+T7cw8z/qixkeNhb2OWeFNhJ7vh/MFnDxIqEnCGmMEBCM2DLo5LA9AWXC4eBaNgFIyCUQAHADWxS35CD5XtAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-8478-8066","institution":"Transilvania University of Brasov","correspondingAuthor":true,"prefix":"","firstName":"Gabriel","middleName":"Osei","lastName":"Forkuo","suffix":""}],"badges":[],"createdAt":"2026-03-03 07:23:36","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9017125/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9017125/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104401235,"identity":"5ff0380c-08a5-4db1-a162-97f652a6967e","added_by":"auto","created_at":"2026-03-11 12:12:10","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2522049,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptMainJCH.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9017125/v1_covered_059b08c4-1301-4f50-8d05-93ee83cceb6e.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eCommunity-Based Interventions for Reducing Neonatal Mortality in Low-Resource Settings: A Scoping Review and Evidence Gap Map\u003c/strong\u003e\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"antenatal care, evidence synthesis, essential newborn care, GRADE framework, perinatal survival, skilled birth attendance","lastPublishedDoi":"10.21203/rs.3.rs-9017125/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9017125/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eNeonatal mortality disproportionately affects sub-Saharan Africa and South Asia, where facility-based care alone often misses vulnerable populations. Consequently, community-based interventions are widely advocated. However, the breadth, quality, and certainty of the supporting evidence lack comprehensive mapping. This study maps the evidence landscape for community-based neonatal mortality interventions to identify critical research gaps.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFollowing JBI scoping review and EPPI-Centre Evidence Gap Map standards, we searched OpenAlex, CrossRef, and Semantic Scholar via Python 3.12, supplemented by grey literature. A purposive, citation-informed corpus of 200 high-impact studies was selected. Quality was assessed using Cochrane RoB 2 (11 RCTs), ROBINS-I (17 non-randomised studies), AMSTAR-2 (4 systematic reviews), CASP (2 qualitative), and a Quality Indicators Checklist (166 non-evaluative studies). High heterogeneity precluded meta-analysis; data were narratively synthesized and evidence certainty assessed using GRADE criteria.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eCommunity health worker (CHW) programmes, participatory women\u0026rsquo;s groups, and essential newborn care (ENC) were evaluated most frequently. Methodological quality was mixed: all 11 RCTs showed \"some concerns\" (RoB 2) and all 17 non-randomised studies indicated \"moderate risk\" (ROBINS-I). Consequently, GRADE certainty for RCT-derived outcomes was very low to moderate, downgraded primarily for indirectness, inconsistency, and imprecision. Narratively, women's groups, CHW home visits, and ENC most consistently reduced mortality. Geographically, within this highly cited corpus, West Africa was substantially underrepresented relative to its severe disease burden.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eModerate-certainty evidence, predominantly from South Asian cluster RCTs, supports the mortality-reducing benefits of specific community packages. However, this geographically skewed and heterogeneous evidence base precludes strong causal conclusions for West African settings, though regional literature may exist outside the queried databases. This review highlights profound gaps in highly cited, rigorous evidence for high-burden regions, emphasizing the need for equitable research investment and the application of advanced causal and adaptive study designs (e.g., quasi-experiments, micro-randomized trials) to guide local policy.\u003c/p\u003e","manuscriptTitle":"Community-Based Interventions for Reducing Neonatal Mortality in Low-Resource Settings: A Scoping Review and Evidence Gap Map","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-04 06:32:06","doi":"10.21203/rs.3.rs-9017125/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5d926729-5605-4bd3-9048-fb422156afec","owner":[],"postedDate":"March 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":63889189,"name":"Nursing"},{"id":63889190,"name":"Preventive Medicine"},{"id":63889191,"name":"Pediatrics"},{"id":63889192,"name":"Epidemiology"}],"tags":[],"updatedAt":"2026-03-04T06:32:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-04 06:32:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9017125","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9017125","identity":"rs-9017125","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}