Table 1
Description of included studies
| Study | Country | Study Design | Data Source | Sample Size | Religious Leaders | Intervention | Results |
|---|---|---|---|---|---|---|---|
| Hembling, et al.22 | Ghana | Quasi-experimental design | Mothers of children ages 0-23 months | Intervention: 484 at baseline and 510 at follow up Comparison: 466 at baseline and 510 at follow up | Protestant ministers, traditional African religious leaders, Islamic imams | Village-level councils comprised of religious leaders, village chiefs, traditional medical practitioners, and female community leaders, were trained to assess a problem, analyze its causes, and act to address the issues. They then led community dialogues to discuss overcoming barriers to engaging in maternal health care. They also conducted home visits to engage heads of households (often the primary decision-makers) and promote practices during religious services | Unadjusted Early ANC: 45.9% increase ≥ 4 ANC visits: 61.3% increase Adjusted Early ANC: β = 2.30 (p < 0.001) ≥ 4 ANC visits: β = 2.24 (p < 0.001) |
| Sadore, et al.23 | Ethiopia | Cluster randomized controlled trial | Pregnant women < 20 weeks gestation | Intervention: 292 women Control: 301 women | Local leaders representing faith-based organizations, chosen based on their religious training, standing and influence, and the endorsement of community leaders, healthcare workers, and local authorities | Religious leaders, trained to support and encourage pregnant women to use recommended healthcare services, conducted four sessions on maternal health topics for their congregations, four group training sessions for pregnant women, and home visits to each pregnant woman to provide additional support and counseling | Unadjusted ≥ 4 ANC visits: 21.4% increase Institutional delivery: 20.0% increase Adjusted ≥ 4 ANC visits: AOR = 2.09 (95% CI: 1.69, 2.57) Facility delivery: AOR = 2.36 (95% CI: 1.94, 2.87) |
| Guthrie, et al.24 | Ethiopia | Cluster randomized controlled trial | Facility-level statistics from pregnant women attending health centers over 12 months | Intervention: 6 facilities Control: 12 facilities | Ethiopian Orthodox priests | Religious leaders and community health workers, trained on maternal health, community outreach and counseling, conducted outreach and education within communities, including in homes and places of worship, and provided referrals and counsel to pregnant women to help overcome barriers to care | Unadjusted None reported Adjusted 1st ANC visits: RR = 1.14 (p < 0.001) 4th ANC visits: RR = 1.26 (p < 0.001) Facility deliveries: RR = 1.10 (p < 0.001) |
| Maiwada, et al.25 | Nigeria | Quasi-experimental design | Facility-level statistics from health centers before and after the intervention | Unspecified number of facilities in urban and rural communities | Imams, Islamic preachers and scholars, Islamiyyah teachers, leaders and administrators of Islamic organizations | Religious leaders, exposed to health promotion, education, and community mobilization activities, were primarily expected to make public pronouncements to change community opinion and improve maternal health | Unadjusted ANC attendance and facility-based delivery significantly increased Adjusted None reported |
| Nasiru26 | Nigeria | Mixed methods study; (presumably) pre-test/post-test design to assess impact of intervention | Community surveys with unspecified number of pregnant women | 200 | Islamic leaders | A radio drama, created with religious leaders, healthcare providers, and community members, encouraged maternal health service utilization | Unadjusted 35% increase in ANC attendance Adjusted None reported |
Table 2
Risk of bias assessment of included studies using the Mixed Methods Assessment Tool (MMAT)
| Study | Study Type | Criteria | ||||
|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | ||
| Hembling, et al.22 | Non-randomized studya | Yes | Yes | Can’t tell | Yes | Yes |
| Sadore, et al.23 | Randomized controlled trialb | Yes | Yes | Yes | Yes | Yes |
| Guthrie, et al.24 | Randomized controlled trialb | Yes | No | Yes | Can’t tell | Yes |
| Maiwada, et al.25 | Non-randomized studya | Yes | Yes | Can’t tell | No | Can’t tell |
| Nasiru26 | Quantitative descriptive studyc,d | Can’t tell | Can’t tell | Can’t tell | Can’t tell | Can’t tell |
a Criteria for non-randomized studies include the following: 1. Are the participants representative of the target population? 2. Are measurements appropriate regarding both the outcome and intervention (or exposure)? 3. Are there complete outcome data? 4. Are the confounders accounted for in the design and analysis? 5. During the study period, is the intervention administered (or exposure occurred) as intended?
b Criteria for randomized controlled trials include the following: 1. Is randomization appropriately performed? 2. Are the groups comparable at baseline? 3. Are there complete outcome data? 4. Are outcome assessors blinded to the intervention provided? 5 Did the participants adhere to the assigned intervention?
c Criteria for quantitative descriptive studies include the following: 1. Is the sampling strategy relevant to address the research question? 2. Is the sample representative of the target population? 3. Are the measurements appropriate? 4. Is the risk of nonresponse bias low? 5. Is the statistical analysis appropriate to answer the research question?
d The quantitative descriptive study section was used to assess risk of bias in the article by Nasiru based on the surveys employed to evaluate the influence of religious leaders on maternal health. Qualitative research was implemented in formative pre-intervention phase to identify key socioreligious barriers to maternal health.