Livestock development programmes for communities in low- and middle-income countries

  • Protocol
  • Intervention

Authors


Abstract

This is the protocol for a review and there is no abstract. The objectives are as follows:

To assess the effects of livestock development programs on indicators of livelihood and health status for communities, families, and individuals in low- and middle-income countries

Background

Description of the condition

Despite significant international efforts, health gaps between the rich and the poor continue to widen around the world, with the largest gaps occurring in the poorest countries (WHO 2005). These results are not surprising given that many indicators of health are strongly linked to poverty, including life expectancy, childhood mortality, maternal health, communicable diseases and mental health (WHO 2005; Lopez 2006; Prince 2007; UN 2007; UN 2012). Poverty also negatively impacts health outcomes through broader determinants of health, such as malnutrition, literacy and environmental conditions, prompting many to approach health and well-being using a framework that incorporates multiple dimensions of poverty. The Sustainable Livelihood Framework expands on the traditional definition of poverty from a simple measure of consumption or income to a more holistic approach which considers five basic types of capital: natural, human, financial, physical and social (DFID 1999; World Bank 2001).  Such an approach defines good health not simply as the absence of disease, but as a measure of human well-being, and more closely represents how the poor perceive poverty (Narayan 2000; World Bank 2001). Poverty reduction strategies focused on the most disadvantaged populations have the potential to impact health positively through multiple pathways by supporting and improving livelihoods through multiple dimensions.

Description of the intervention

It has been estimated that globally, two-thirds of poor rural households keep livestock (LID 1999). The poor may employ different livelihood strategies in regard to livestock keeping, using them simply as a means of savings and protection from inflation, for subsistence and as a buffer against household shocks, or for the accumulation of assets (Kitalyi 2005).  Given these potential roles and strategies, Morton 2000 has suggested classifying livestock as natural, financial and/or social capital under the Sustainable Livelihood Framework.

Non-governmental organizations (NGOs) and government agencies in high-income countries have invested significantly in livestock development programs as a means to alleviate poverty. The complex relationships between livestock keeping and the poor provide a multitude of entry points for livestock based interventions, which is reflected in the structural variability of livestock programs. The most widely recognized type of livestock intervention is the rotational lending scheme, in which the initial investment for livestock purchase is made by the donor, and the recipient is expected to repay this loan by passing on offspring from the livestock to other community members. This type of program allows the poor to overcome a lack of financial capital and/or credit acquisition for initial livestock purchase (Heffernan 2005). Other programs have promoted increased animal production as a means to improve beneficiary nutritional status (Leroy 2007). In Kenya, the Ministry of Agriculture implemented the National Dairy Development Program to increase local dairy production by smallholder farmers in order to meet local demands. The program supported increased dairy production through a zero-grazing based program with crossbred cows and cultivated fodder. In the Kilifi District of the Coast Province, this program was shown to increase household income, food purchases, school fee payments and book purchases; beneficiary households also reported increased intake of animal protein through increased household milk consumption (Mullins 1996). Alternatively, a program may focus on improving livestock health directly, leading to improved programmatic and beneficiary outcomes. Livestock kept by the poor are vulnerable to disease and poor health due to increased exposure to infectious disease agents, suboptimal management, and lack of access to animal health services (Perry 2005). Frequently, the poor have relatively few animals, and therefore the loss of an individual animal has greater significance compared to farmers with fewer resource limitations. Kneuppel 2010 studied the effects of a Newcastle disease vaccination program for chickens on household food intake and food insecurity in rural Tanzania. Newcastle disease is a viral disease which can cause up to 100% mortality in unvaccinated chicken flocks (Sonaiya 2004), but can be mitigated with an economical and easily administered vaccine (Foster 1999). The study found that households that participated in the vaccination program had increased ownership of chickens and increased household egg consumption compared to control households not participating in the program.

How the intervention might work

Livestock play pivotal roles in the livelihoods of the poor, not only by producing food, but by generating income, increasing crop productivity through manure production and draught power, acting as living savings accounts, and enhancing social status (Randolph 2007). The Sustainable Livelihoods Framework provides a way to describe different household assets and what roles those assets play in risk mitigation and strategy development, leading to improved livelihoods (Figure 1; Carney 1998). The Framework also provides a theoretical basis to explore the ways in which livestock may contribute to different assets and/or livelihood strategies (Randolph 2007).

Figure 1.

The Sustainable Livelihoods Framework classifies household resources into five types of assets and theorizes how families address risk and vulnerability in the context of outside influences to create livelihood strategies. Livestock keeping can potentially contribute to each type of asset and impact the livelihood outcomes for households. Adapted from the Sustainable Livelihoods Framework ( Carney 1998 ) and how livestock may influence the framework ( Randolph 2007 ).

The five types of household assets are indicated within the dotted box in Figure 1: human, financial, physical, natural and social. Households face a wide range of risks (vulnerabilities) which can impact household assets and livelihoods. Depending on available household assets and outside influences (government agencies, social context, policies, etc.) households create livelihood strategies to mitigate risk and vulnerability. If successful, the outcomes of these strategies reinforce and improve the household asset base. Within this theoretical framework, livestock programs can improve livelihoods by positively impacting each type of household asset (Figure 1; solid boxes with dashed arrows leading to household asset category).

While the true interrelationships between livestock interventions and household activities are likely best represented by a web of feedback loops with positive and negative impacts (Randolph 2007), a simplified analytic framework representing the proposed theoretical underpinnings of livestock interventions in low- and middle-income countries was adapted to guide this review (Figure 2; Carney 1998, Randolph 2007). Livestock interventions have a variety of immediate outcomes related to household physical, financial, natural and social assets, such as the acquisition of assets, improved financial status through income or non-cash proxies and improved soil fertility through the use of manure. These immediate or proximate outcomes are linked to directly measurable health outcomes through a causal pathway that includes intermediate outcomes which correlate to livelihood indicators and household assets. Understanding these pathways is key to understanding how livestock interventions truly impact individuals and communities, and to the development of improved, evidence-based initiatives in the future.

Figure 2.

An analytic framework for the impact of livestock interventions on indicators of livelihood (*) and directly measurable human health outcomes (square boxes) in low- and middle-income countries (Adapted from Carney 1998 and Randolph 2007). Dotted arrows represent postulated associations between secondary outcomes on the proposed causal pathway and primary human health outcomes, while potential negative impacts are also considered (oval).

Why it is important to do this review

Livestock development programs have a long history as a means of poverty alleviation for the poor globally; however, the relationships between livestock keeping and a family’s livelihood strategies are very complex, with both positive and negative impacts on outcome measures for household assets. Evaluating the effects of such interventions is difficult and requires a carefully designed study intervention as well as local, contextual knowledge of the livestock/human/poverty interface for the targeted population (Randolph 2007). Additionally, the long history of international livestock programs provides an opportunity to review and assess the costs associated with program design, implementation and evaluation. To date, no systematic review of livestock interventions and the resulting impact(s) on health or well-being (or both) has been conducted. Such a review will improve the understanding of the complex relationships illustrated above, and lead to a theoretical framework for best practices, including cost-benefit analyses, that could be applied and adapted to a multitude of settings. The promise of improving the livelihoods of vulnerable populations and the continued investment in livestock programs by government and development organizations justifies the need to more fully understand and evaluate such interventions.

Objectives

To assess the effects of livestock development programs on indicators of livelihood and health status for communities, families, and individuals in low- and middle-income countries

Methods

Criteria for considering studies for this review

Types of studies

Published or unpublished randomized controlled trials (individual, cluster, step-wedge or quasi-randomized).

We will include individual, cluster, and step-wedge non-randomized studies (NRS) in the review and evaluate them separately, because randomization is infrequent in livestock development interventions. We will also include non-randomized, controlled, before and after (CBA) studies and studies with historical controls, to increase the external validity of the review, as long as the intervention was prospective, and the study used at least one control group created through eligibility criteria (Higgins 2011). Similarly, we will include interrupted time series (ITS) studies if the intervention time point is clearly defined and if data are collected at least three time points before and after the intervention. Qualitative data and/or studies linked to primary included studies will be included to help contextualize the review findings. There will be no limitations on time or language.

Types of participants

We will include communities in low- or middle-income countries (LMICs) as defined by the World Bank at the time of the study (World Bank 2010). A community will be generally defined as a group of people linked by geography, common ties, and social interaction (MacQueen 2001). Units of interest are communities, and within a community, individuals, heads of household, his or her family, and extended family units. We will not use demographic or social factors as inclusion or exclusion criteria (e.g. age, sex, education level).

Types of interventions

We will include livestock programs in which any livestock species was provided to individual members or households in the community, either free of charge, as a loan, or for a fee. 'Livestock' will be interpreted broadly and will include aquaculture and apiculture, in addition to more traditional species such as poultry, goats, rabbits, and cattle. We will also include interventions which provide technical support for animal health, such as educational programs, breed improvement programs or programs to improve livestock production. We will exclude microfinance interventions that are agriculturally based but not centered on livestock, such as programs for crop improvement or water issues.

Programs may be short or long term and may be supported by government agencies, non-governmental organizations (NGOs), academic institutions or other organizations working in development and poverty. Individuals or groups in the same or similar communities that did not participate in the livestock program will act as a comparison group. Comparison groups may have no intervention, or may have participated in an alternate intervention (educational intervention, other agricultural program). There may be historically-controlled studies (which compare results to a similar population in the past) or studies with a sequential roll-out of the intervention to participants over a number of time periods so that all participants eventually receive the intervention in random order (step-wedge study design, Brown 2006).

Types of outcome measures

Primary outcomes

Primary outcomes will be changes in any human health outcome measured at the individual level, which may include, but are not limited to, the following:

  • General health status (e.g. SF-36)

  • Mortality (e.g. age-specific or disease-specific mortality)

  • Nutritional status (e.g. wasting, weight for age, height for age, body mass index)

  • Morbidity (e.g. disease prevalence and/or incidence)

  • Mental health (e.g. depression, trauma, anxiety, mental and physical functioning)

  • Harms (e.g. zoonotic disease incidence and/or prevalence, food-borne illness, unintended consequences)

Secondary outcomes

Secondary outcomes of interest, measured at the individual or family/household level, are those hypothesized to be on the causal pathway between livestock interventions and human health outcomes, and include proximate and intermediate livelihood outcomes which may include, but are not limited to, the following:

  • Food security (e.g. dietary changes, household food insecurity assessment, animal source protein consumption, water contamination)

  • Utilization of healthcare services (e.g. number of visits to healthcare facility, hospitalization, changes in health-seeking behaviors)

  • Social status and empowerment (e.g. self-esteem, self-advocacy, gender-related violence)

  • Education (e.g. enrollment in school, retention in school, gender-based enrollment)

Studies that only report livestock-related indicators, such as livestock morbidity, mortality or production, or process indicators for program implementation (e.g. how many animals distributed, training conducted) will be excluded from the review.

Outcomes to be reported in 'Summary of findings' tables are listed at Data synthesis.

Search methods for identification of studies

Electronic searches

We will formulate a comprehensive search strategy in an attempt to identify all relevant studies regardless of language or publication status (published, unpublished, in press, and in progress). Electronic searches of databases will be conducted by a librarian. We will use the search strategy for MEDLINE provided in Appendix 1, and will modify and adapt it as needed for use in the other databases. All languages will be included. Because of the multidisciplinary nature of livestock development interventions, we will search databases from a variety of disciplines, including health, social science, agriculture, development and economics. We will search the following electronic databases, from 1950 to the search date:

Health

  • African Index Medicus (AIM)

  • CENTRAL (the Cochrane Central Register of Controlled Trials, The Cochrane Library)

  • CINAHL (Cumulative Index to Nursing and Allied Health Literature; EBSCOhost)

  • EMBASE (OvidSP)

  • Global Health Library

  • MedCarib (Virtual Health Library)

  • MEDLINE (Ovid MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE; OvidSP)

  • PsycINFO (ProQuest)

  • SAMED (South African Medical Database)

  • WHOLIS

Public health

  • Cochrane Public Health Group Specialized Register

Animal health/livestock

  • ACSESS Digital Library (Alliance of Crop, Soil, and Environmental Science Societies)

  • AGRICOLA (United States National Agricultural Library)

  • AGRIS (International Information System for the Agricultural Science and Technology Database).

  • CABI (Commonwealth Agricultural Bureaux International): CAB Abstracts, CAB Abstracts Archive, CAB Direct, Global Health and Global Health Archive

  • Web of Science (Science Citation Index Expanded, Social Sciences Citation Index, Conference Proceedings Citation Index; Web of Knowledge)

 

Social Science

  • Web of Science/Social Sciences Citation Index (Web of Knowledge)

  • SSRN (Social Science Research Network)

Development and economics

  • 3ie Database of Impact Evaluations

  • AgEcon (Research in Agricultural and Applied Economics)

  • British Library for Development Studies (BLDS)

  • ECONLIT (EBSCOHost)

  • Eldis (Institute of Development Studies)

  • HEED (Health Economics Evaluation Database)

  • JOLIS (International Monetary Fund, World Bank, and International Finance Corporation)

  • Microfinance Gateway

  • NHS EED (NHS Economic Evaluation Database)

  • POPLINE

  • RePEc (IDEAS Economic and Finance Database)

  • World Bank – Documents and Reports

 

Grey literature

  • Dissertation Abstracts (ProQuest)

  • OpenSIGLE

Searching other resources

We will search the reference lists of included studies and reviews to identify potentially relevant studies. We will contact experts, and search websites and online resources of relevant organizations (e.g. WHO, FAO, UNICEF, USAID, DFID, SIDA, NORAD, and the World Bank) for relevant grey literature . We will contact authors of relevant studies for additional information and unpublished work. We will also search the electronic tables of contents of the journals which have published the majority of included studies, for the same time period (1950 to the search date).

Data collection and analysis

Selection of studies

The methodology for data collection and analysis will be based on the guidance of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).  Two authors (DCB and MLL) will independently review the titles and abstracts of all studies identified by the searches.  Where necessary, we will obtain the full text to determine the eligibility of studies for inclusion. Potentially-eligible studies in other languages will be translated into English for review. We will obtain the full text of papers potentially meeting the inclusion criteria, and two authors (DCB and MLL) will independently review them to establish the relevance of each article according to the pre-specified criteria. If additional information is needed to determine eligibility for inclusion, we will contact the authors of such studies. Compiled lists of potentially eligible studies from each review author will be compared and discrepancies in inclusion and exclusion will be resolved through discussion and consensus with a third author (SHV). Author names, intervention details, location and settings and baseline data will be compared for selected studies to identify multiple reports of the same study which may duplicate findings. Those study authors will be contacted for confirmation if necessary. Records retrieved from searches will be managed with EndNote.

Data extraction and management

We will develop a data extraction and management tool using the Cochrane Public Health Group’s Data Extraction and Management Tool (Appendix 2). The tool will be pilot-tested and modified as necessary before we start the formal review. Data will be extracted from eligible studies by two co-authors (DCB, MLL) using this adapted tool and disagreements will be resolved through discussion among all co-authors. One author (DCB) will compile the extracted data and enter them into Review Manager 5.1 (RevMan 2011) for storage and analysis and a second author (MLL) will check the entered data. We will collect the following categories of data from each study: 

  • Administrative details: identification number, authors, published or unpublished, year of publication

  • Study characteristics: study design, time period, location, type, duration and completeness of follow-up,  location and setting

  • Details of participants: target population, age, gender

  • Intervention characteristics and design

  • Comparison groups: demographics, alternate interventions

  • Details of outcomes: primary, secondary, harms

  • Details necessary for 'Risk of bias' assessment

 

We will extract data on context, equity, cost and sustainability when available, and report the data in the Characteristics of Included Studies table. Data for indicators of disadvantage (PROGRESS indicators; Evans 2003), as well as all potential confounders and effect modifiers of reported outcomes will also be extracted. When additional, non-primary studies contain essential information on methodology or progress evaluation of eligible studies, we will obtain them and include them in the review. In addition, we will extract qualitative data from primary studies and supporting reports to assist in the interpretation of major findings.

If a study reports multiple measures of the same or similar outcomes, the best direct measurement will be selected by review author consensus. If the same outcome is measured at multiple time points, all data from each time point will be extracted in order to synthesize data from multiple studies with similar follow-up time periods. If directly measurable health outcomes are reported, data will also be collected on proximate and intermediate outcomes measured that supported and/or promoted changes in those health outcomes.

Assessment of risk of bias in included studies

Two review authors (DCB and MLL) will independently assess the risk of bias of each included study. Disagreements will be resolved through discussion among all review authors. For RCT, non-RCT, CBA, and ITS studies, we will evaluate the risk of bias using tools developed by the Cochrane Effective Practice and Organization of Care Group (Appendix 3). Given that the intervention is typically delivered at the cluster level (household, community, group), blinding is unlikely. The risk of bias will be classified as ‘low risk,’ ‘high risk,’ or ‘unclear risk.’ A review author will attempt to contact study authors for additional information in cases where the risk of bias is ‘unclear.’ The risk of bias will be summarized by main outcomes for each study and also summarized for outcomes across studies. We will take into account the results of the 'Risk of bias' assessment in the interpretation of the review's findings.

Measures of treatment effect

For RCTs, we will calculate the relative risk (RR) and the 95% confidence interval for dichotomous outcomes .  For continuous data, we will report means, and changes in mean scores, and calculate the mean difference (MD). When studies use different scales to report the same outcome, we will use standardized mean differences (SMDs). We expect that included studies will have variability in their intervention structure and strategy, and will also report a variety of outcome measures; therefore, it is unlikely that a single meta-analysis will be sufficient or appropriate. We will analyze RCTs separately from non-randomized studies. For non-randomized studies, data will be combined across studies in a meta-analysis using an inverse-variance weighted average if review authors reach a consensus on studies that are relatively resistant to biases and are homogenous with respect to study design, interventions and outcome measures.

Unit of analysis issues

As with other community interventions, the level of randomization or allocation may be at the individual or cluster level (household, group, community). In cluster randomized or allocated studies, we will determine the level at which outcomes were measured and whether or not the clustering was considered in the analysis. If methods to adjust for clustering were not used, we will adjust the analysis to account for intra-cluster correlation (ICC) by re-analyzing the data with robust variance estimates and/or contacting the study authors for additional information. If a study has multiple intervention groups, we will evaluate all groups against inclusion/exclusion criteria. If more than one intervention group is eligible, these data will either be collapsed into a single intervention group, or we will make pairwise comparisons between each eligible intervention group and the control group in separate analyses.

Dealing with missing data

When data are missing or are unclear in included studies, we will contact study investigators for additional information and/or clarification through contact information provided in published studies, as well as through contact information found for study authors at affiliated institutions. We will indicate when we were unable to obtain missing data for studies in the review and discuss the potential impact that missing data had on the review findings.

Assessment of heterogeneity

Given the broad nature of our review and the variability of populations, interventions and study designs for livestock programs implemented globally, we expect to find both clinical and methodological heterogeneity across included studies. We will work together to reach a consensus on grouping eligible studies which are homogeneous with respect to participants, interventions and outcomes for analysis. Within these groups, the level of heterogeneity will be quantified using the I2 statistic (percent of the variation due to heterogeneity rather than chance). As a default, we will use a random-effects model to incorporate heterogeneity into our meta-analysis.  

Assessment of reporting biases

Our proposed search strategies reduce potential publication bias by including searches of the grey literature and methods to find and incorporate unpublished studies. We will further investigate publication bias in eligible studies through funnel plots and contour-enhanced funnel plots if the studies are homogeneous with respect to participants, interventions, and outcomes. Heterogeneity alone in intervention effects could result in asymmetric funnel plots, therefore limiting our ability to identify publication bias. If there are a sufficient number of homogeneous studies, we will use Egger’s linear regression to statistically evaluate funnel plot asymmetry and the impact of publication bias.

Data synthesis

Where possible, we will group studies by study design, intervention structure and strategy and outcomes. If there are sufficient studies within each grouping, we will conduct separate meta-analyses.  We will use a DerSimonian and Laird random-effects model, using Review Manager 5 software (RevMan 2011) and present results using the Mantel-Haenszel rate ratio. If meta-analysis is deemed inappropriate (i.e., there are fewer than two eligible studies), summary information from groups of studies will be synthesized and presented in the review narrative.

'Summary of findings' tables

We will present the results of data synthesis by either or both of these methods in one or more 'Summary of findings' tables. Primary outcomes of interest to be included in a 'Summary of findings' table are: general health status, underweight (weight for age), stunting (height for age), wasting (weight for height), body mass index, death, and depression. A second 'Summary of findings' table for secondary outcomes of interest will include: food insecurity, animal source protein consumption, school enrollment, self-esteem, income or income proxy, number of health facility visits, and number of hospitalizations. We will assess the body of evidence for each outcome presented in the 'Summary of findings' tables using the GRADE approach (study limitations, consistency of effect, precision of effect estimate, directness of the evidence, and publication bias) and guidelines presented in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).

Subgroup analysis and investigation of heterogeneity

If there are two or more eligible studies, we will conduct subgroup analyses based on population, intervention structure and strategy, and study setting/context to examine if intervention effect varies. Potential subgroups will be based on 1) age, 2) gender, 3) intervention strategy, 4) co-morbidities (e.g., HIV), 5) geographical location, and 6) income/poverty status. We will conduct separate meta-analyses when appropriate; otherwise, we will summarize the results for subgroups in the review narrative. Assessment of heterogeneity, as described above (see Assessment of heterogeneity), will be repeated for any subgroup analyses.

Sensitivity analysis

We will conduct sensitivity analyses as necessary based upon specific decisions made in the review process.  For example, we may repeat analysis excluding studies with poor GRADE ratings, or studies perceived as outliers.  If sufficient data are available, we may examine whether overall results are reproducible at a regional level.

Acknowledgements

We thank and acknowledge the members of our review advisory group, who provided essential input to make the review relevant to the international community, and the Cochrane Public Health Group team for assistance in the development of the protocol.

Appendices

Appendix 1. MEDLINE Search Strategy

1. Livestock/

2. Poultry/

3. Animal Husbandry/

4. Animal Welfare/

5. exp Veterinary Medicine/

6. exp Aquaculture/

7. Beekeeping/

8. Dairying/

9. exp Ruminants/

10. exp Swine/

11. exp Lagomorpha/

12. Guinea Pigs/

13. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12

14. Poverty/

15. Food Supply/

16. exp Financing, Government/

17. exp Financial Support/

18. Financing, Organized/

19. Economic Development/

20. 14 or 15 or 16 or 17 or 18 or 19

21. 13 and 20

22. ((Livestock or cattle or poultry or (animal adj3 (production or care or husbandry or welfare)) or swine or pig* or sheep or goat* or rabbit* or chicken or bee or bees or aquaculture or apiculture or (fish* adj3 (farm* or stock* or production or care)) or equine or horse* or mule* or ruminant* or grasscutter* or camel* or camelid or buffalo* or yak or llama* or ox or oxen) adj5 (educat* adj3 (program* or project* or scheme* or plan)) adj5 (income* or livelihood* or food* or health or wealth or household* or poverty or well-being or wellbeing or (life adj2 qualit*) or diet* or nutrition* or malnutrition or undernutrition or morbi* or mortalit* or disease* or asset* or (life adj expectancy))).tw

23. ((Livestock or cattle or poultry or (animal adj3 (production or care or husbandry or welfare)) or swine or pig* or sheep or goat* or rabbit* or chicken or bee or bees or aquaculture or apiculture or (fish* adj3 (farm* or stock* or production or care)) or equine or horse* or mule* or ruminant* or grasscutter* or camel* or camelid or buffalo* or yak or llama* or ox or oxen) adj5 (program* or project* or enterprise* or intervention*) adj5 (income* or livelihood* or food* or health or wealth or household* or poverty or well-being or wellbeing or (life adj2 qualit*) or diet* or nutrition* or malnutrition or undernutrition or morbi* or mortalit* or disease* or asset* or (life adj expectancy))).tw

24. ((Livestock or cattle or poultry or (animal adj3 (production or care or husbandry or welfare)) or swine or pig* or sheep or goat* or rabbit* or chicken or bee or bees or aquaculture or apiculture or (fish* adj3 (farm* or stock* or production or care)) or equine or horse* or mule* or ruminant* or grasscutter* or camel* or camelid or buffalo* or yak or llama* or ox or oxen) adj5 (fee or fees or free or loan* or supplie* or supply or finance or enterprise or lend* or credit*) adj5 (income* or livelihood* or food* or health or wealth or household* or poverty or well-being or wellbeing or (life adj2 qualit*) or diet* or nutrition* or malnutrition or undernutrition or morbi* or mortalit* or disease* or asset* or (life adj expectancy))).tw

25. ("livestock development program*" or "livestock development strateg*" or "livestock development project*" or (dairy adj3 co-operative) or "national diary development program" or "Family Health and Rural Improvement Program" or "Basic Animal Health Service").tw

26. 21 or 22 or 23 or 24 or 25

 

Appendix 2. Data Extraction and Management Tool

Study ID: Report ID : Date form completed:
First author: Year of study:Data extractor:

Citation:

 

 

1. General Information

Publication type:

□ Journal article

□ Abstract

□ Other (specify e.g. book chapter)_____________

Country of study: 
Funding source of study:Potential conflict of interest from funding?Yes □     No □    Unclear □

 

2. Study Eligibility

Study Characteristics  

Page/

Para/

Figure #

Type of study

 

□ Randomised Controlled Trial (RCT)

□ Cluster Randomised Controlled Trial (cluster RCT)

□ Quasi-Randomised Controlled Trial (quasi-RCT)

□ Controlled Before and After (CBA) study

  • Prospective

  • At least one control group

□ Interrupted Time Series (ITS)

  • At least 3 time points before and 3 after the intervention

  • Clearly defined intervention point

 
□ Other design (specify): □ A process evaluation of an included study design□ Qualitative study design which provides data to contextualize findings 

Does the study design meet the criteria for inclusion?

Yes □     No □ -> Exclude Unclear □

   
Description in text: 
ParticipantsDescribe the participants included: 
Are participants defined as a group having specific social or cultural characteristics?

Yes □ No □ Unclear □

Details:

 
What is the unit of interest for the intervention?

Individual □ Household □ Community □

Other:

Details:

 
How is the geographic boundary defined?

Details:

Specific location (e.g. state / country):

 
Does the intervention take place in an LMIC?

Yes □ No □ Unclear □

Details:

 
Do the participants meet the criteria for inclusion?Yes □ No □ -> Exclude Unclear □ 

Types of

Interventions

Is the intervention a livestock program?Yes □ No □ -> Exclude Unclear □ 
Does the intervention provide livestock to participants?Yes □ No □ -> Exlcude Unclear □ 
What species of livestock is used in the intervention?  

What is the intervention strategy?

Under what circumstances were livestock given to participants?

Free/Gift □ Loan □ Sold □

Other:

Details:

 

Did the intervention ONLY support activities for previously

or currently owned livestock?

Yes □ -> Exclude No □ Unclear □ 
Does the intervention meet the criteria for inclusion?Yes □ No □ -> Exclude Unclear □ 

Types of

outcome

measures

List participant outcomes:  
Outcome measured at a population level or individual level?

Individual □ Household/family □

Community □ Population □ Other □

Details:

 
List livestock outcomes:  
Does the study ONLY report livestock related indicators or process indicators?Yes □ -> Exclude No □ Unclear □ 
Do the outcome measures meet the criteria for inclusion?Yes □ No □ -> Exclude Unclear □ 

Summary of assessment for Inclusion

Include in review □         Exclude from review □
Independently assessed, and then compared? Yes □   No □

Differences resolved? Yes □   No □

Details:

Request further details? Yes □   No □Contact details of authors:
Notes:

DO NOT PROCEED IF PAPER EXCLUDED FROM REVIEW

3. Study details                                                                                                                                                                                   

Study intention Descriptions as stated in the report/paper Page/ Para/ Figure #
Aim of intervention What was the problem that this intervention was designed to address?  
Aim of study What was the study designed to assess? Are these clearly stated? 
Equity pointer: Social context of the study (e.g. was study conducted in a particular setting that might target/exclude specific populations? See also Inclusion/exclusion criteria under Methods, below) 
Start and end date of the study Identify which elements of planning of the intervention should be included 
Total study duration   
Methods Descriptions as stated in the report/paper Page/ Para/ Figure #

Method/s of recruitment of participants

(How were potential participants approached and invited to participate? Where were participants recruited from? Does this differ from the intervention setting?)

   
Inclusion/exclusion criteria for participation in study as described in the text   
What was the community setting or context for the intervention?   
Representativeness of sample: are participants in the study likely to be representative of the target population?

Yes □    No □    Unclear □

Details:

 
Total number of intervention groups    

Assumed risk estimate

Outcome:

(e.g. baseline or population risk of outcome of interest noted  in Background)

References:  

Sample size calculation:

  • Was a sample size calculated?

  • What assumptions were made?

  • Were these assumptions appropriate?

 

Yes □    No □    Unclear □

Assumptions:

Yes □    No □    Unclear □

 
Who/what were the comparison groups?   
How were comparison groups selected? (i.e. eligibility criteria)   

What was the unit of randomization?

Allocation by individuals or cluster/groups

Individual □    Household/family □ 

Community □  Population □   Other □

Details:

 

What was the unit of analysis?

 

 

 

Is this the same as the unit of randomization?

Individual □    Household/family □ 

Community □  Population □   Other □

Details:

 

Yes □    No □   Unclear □

 
Were statistical methods used appropriate for the study design?Yes □    No □   Unclear □  
Were data collection tools shown to be valid?Yes □    No □   Unclear □  
Were data collection tools shown to be reliable?Yes □    No □   Unclear □  

 

Results

Participants

Include if relevant

Include information for each group (i.e. intervention and controls) under study Page/ Para/ Figure #
  • What percentage of selected individuals agreed to participate?

  
  • Total number randomized (or total pop. at start of study for NRCTs)

  
  • Number allocated to each intervention group (no. of individuals)

  
  • For cluster trials, number of clusters, number of people per cluster

  
  • Where there any significant baseline imbalances?

Yes □  No □  Unclear □

Details:

 
  • Number and reason for (and sociodemographic differences of) withdrawals and exclusions for each intervention group

  
  • Were participants who entered the study adequately accounted for?

  
  • What percentage of participants completed the study?

  
  • What percentage of participants received the allocated intervention or exposure of interest?

  
  • Age (median, mean and range if possible)

  
  • Sex

  
  • Race/Ethnicity

   

  
  • Principal health problem(s) (incl. stage of illness)

  
  • Diagnostic criteria

  
  • Co-morbidity

 

 

 

 
  • Other socio-demographics (e.g. Educational level, literacy level, soci-economic status, first language. Also consider possible proxies for these e.g. low baseline nutritional status)

  
  • PROGRESS categories reported at baseline (indicate letters of those reported: Place of residence, race, occupation, gender, religion, education, SES, social capital)

Place of residence:

Race:

Occupation:

Gender:

Religion:

Education:

SES:

Social capital

 
  • Confounders (other confounders or effect modifiers measured in the study)

  
Subgroups Enter a description of any participant subgroups from this paper to be analyzed in the review. 

 

Intervention Group 1  
    
(copy and paste table for each Intervention group)                                                                                                                    

Group name: (State brief name for this intervention group.)       Page/ Para/ Figure #
Details of intervention or control condition  (Include if relevant in sufficient detail for replication)
  • Settinge.g. multicentre, university teaching hospitals, rural, metropolitan, school, workplace, community, GP clinic, etc.

  
  • Theoretical basis (include key references)

  
  • Content (list the strategies intended and delivered)

  
  • Did the intervention include strategies to address diversity/disadvantage?

Enter a description of any relevant strategies 
  • Delivery (e.g. Stages (sequential or simultaneous), timing, frequency, duration, intensity, fidelity – process indicators)

  
  • Providers (who, number, education/training in intervention delivery, ethnicity etc. if potentially relevant to acceptance and uptake by participants

  
  • Co-intervention

  
Duration of intervention  
Duration of follow-up  
Was sustainability discussed by the authors? Was sustainability a consideration in study development?  
Economic variables i.e. costs of the intervention, and changes in other (e.g. health care)  costs as result of interventionª

Yes □ List in Outcome section if appropriate

No □   Unclear □

Details:

 
Other economic information (from a societal, non-healthcare view – e.g. lost wages, time, non-income based assets)

Yes  □ No   □

Details:

 
Resource requirements to replicate intervention (e.g. staff numbers, hours of implementation, equipment?)  
Subgroups Enter a description of any intervention subgroups from this report to be analyzed in the review. 
What are the moderators/mediators of changes stated in the study?   
Do the authors describe any political or organizational context? List relevant dot points 
Were any partnerships referred to? List these as dot points 
Was a process evaluation conducted? What components were included in the process evaluation? (e.g. dose, frequency, consistency, implemented as intended etc) 
Control/comparison (what information is provided about what the control or comparison group received?) Enter a description of what was provided for the control group, if applicable 

 

Outcomes

(This table is set up for 2 outcome measure to save spaces, copy and paste table as often as required)

Question Outcome 1 Page/ Para/ Figure # Outcome 2 Page/ Para/ Figure #
Is there an analytic framework applied (e.g. logic model, conceptual framework)?      
Outcome definition (with diagnostic criteria if relevant)      
Type of outcome: Is this a modifiable variable (Community level, neighborhood level, individual level) or desired health outcome      
Time points measured    
Time points reported    
Is there adequate latency for the outcome to be observed?    
Is the measure repeated on the same individuals or redrawn from the population/community for each time point?    
Unit of measurement (if relevant)    
For scales – upper and lower limits and indicate whether high or low score is good    
How is the measure applied? Telephone survey, mail survey, in person by trained assessor, routinely collected data, other     
How is the outcome reported? Self or study assessor    
Is this outcome/tool validated?    
…And has it been used as validated tool in this community? Country?    
Is it a reliable outcome measure?    
Is there adequate power for this outcome?    
Were PROGRESS categories analyzed by outcome? Indicate the letters of those that outcomes were analyzed by (place of residence, race, occupation, gender, religion, education, SES, social capital)    

Results Copy and paste the appropriate table for each outcome and subgroup at each time point, including baseline 

For RCT/CCTs

Dichotomous outcomes                  
                                                                                                                                      

   Page/Para/Fig #
Comparison  
Outcome  
Subgroup  
Time point  

Results

 

 

Intervention Comparison 
EventsNo. participantsEventsNo. participants 
     
No. of missing participants and reasons

 

 

 

 
Any other results reported

 

 

 

Reanalysis required? (specify -

(e.g. correlation adjustment)

 

 

 
Reanalysis possible?

yes/no/unclear

 

 
Reanalyzed results   

 

For RCT/CCTs

Continuous outcomes                                                                                                            

   Page/Para/Fig #
Comparison  
Outcome  
Subgroup  
Time point  
Post-intervention or change from baseline?  
Results Intervention Comparison
 MeanSD (or other variance)No. participantsMeanSD (or other variance)

No. participants

 

 
       
No. missing participants and reasons

 

 

 

  
Any other results reported

 

 

 
Reanalysis required? (specify)

 

 

 
Reanalysis possible?

Yes □  No □  Unclear □

 

 
Reanalyzed results   

 

For RCT/CCTs

Generic inverse variance method

Comparison  Page/Para/Fig #
Outcome  
Subgroup  
Time point  
ResultsEffect estimateSE (or other variance)Intervention no.Control no. 
    
No. missing participants and reasons  
Any other results reported  
Reanalysis required? (specify)   
Reanalysis possible?Yes □  No □  Unclear □ 
Reanalyzed results   

For CBAs

Comparison  Page/Para/Fig #
Assignment

How were control and treatment groups selected? Is there likely to be an effect if these were the opposite way?

 

 
 

Contemporaneous data collection?

 

 
Outcome  
Subgroup  
Time point  
Post-intervention or change from baseline?  
  Intervention Comparison 

No. participants

measured

   
No. missing participants and reasons   
Baseline result (with variance measure)   
Post-intervention results (with variance measure)   
Change (Post – baseline) (with variance measure)   
Difference in change (intervention – control) (with variance measure)  
Any other results reported  
Reanalysis required? (specify)   
Reanalysis possible?Yes □  No □  Unclear □ 
Reanalyzed results   

 

For ITS

Generic inverse variance method                                                                                                                                                                                               

Comparison  Page/Para/Fig #
Outcome  
Subgroup  
Length of time points measured  
Snapshot or interval measured   
No. participants measured  
No. missing participants and reasons  
 Pre-interventionPost-intervention 
No. of time points measured   
Mean value (with variance measure)   
Difference in means (post – pre)  
Percent relative change  
Result reported by authors (with variance measure)  
Reanalysis required? (specify)   
Reanalysis possible?Yes □  No □  Unclear □ 
Individual time point results   
Read from figure?Yes □  No □ 
Reanalyzed resultsChange in levelSEChange in slopeSE 
    

 

For qualitative studies

Comparison  Page/Para/Fig #
AssignmentHow were control and treatment groups selected?? Is there likely to be an effect if these were the opposite way? 
 Contemporaneous data collection? 
Outcome  
Subgroup  
Time point  
Qualitative methods used  
Post-intervention or change from baseline?  
  Intervention Comparison 

No. participants

measured

   
No. missing participants and reasons   
Baseline result (with variance measure)   
Post-intervention results (with variance measure)   
Change (Post – baseline) (with variance measure)   
Difference in change (intervention – control) (with variance measure)  
Any other results reported  
Reanalysis required? (specify)   
Reanalysis possible?Yes □  No □  Unclear □ 
Reanalyzed results   

 

Other relevant information                                         

  Review Author’s Judgment/notes

Page/

Para/

Fig #

Were outcomes relating to harms/unintended effects of the intervention described?

Include any data for these in the outcomes tables above

  

Potential for author conflict i.e. evidence that author or data collectors would benefit

if results favored the intervention under study or the control

  
Key conclusions of the study authors  

Could the inclusion of this study potentially bias the generalizability of the review?

Equity pointer: Remember to consider whether disadvantaged populations may

have been excluded from the study.

  

Is there potential for differences in relative effects between advantaged and

disadvantaged populations? (e.g. are children from lower income families less

likely to wear bicycle helmets)

  

Are interventions likely to be aimed at the disadvantaged?

(e.g. school meals aimed at poor children).

  

Issues affecting directness (Note any aspects of population,

intervention, etc. that affect this study’s direct applicability to the review question)

  
References to other relevant studies   
Additional notes by review authors   
Correspondence required for further study information (from whom, what and when)   

 

a. Costs associated with the intervention can be linked with provider or participant outcomes in an economic evaluation (depends on the type of economic evaluation)

Appendix 3. Risk of Bias Tool (adapted from EPOC RoB tools)

 

Domain Review Author’s Judgment Description

Page/Para/

Fig #

Was the allocation sequence adequately generated?

Yes (low risk)

No (high risk)

Unclear

Describe the method used to generate the allocation sequence in sufficient detail to allow an assessment of whether it should produce comparable groups.

 

 
Was the allocation adequately concealed?

Yes (low risk)

No (high risk)

Unclear

Describe the method used to conceal the allocation sequence in sufficient detail to determine whether intervention allocations could have been foreseen in advance of, or during, enrolment. 
Were baseline outcome measurements similar?

Yes (low risk)

No (high risk)

Unclear

Note whether baseline outcome measurements were reported and whether there were any important differences between groups. If there were important differences between groups, note whether appropriate adjusted analysis was performed to account for this. 
Were baseline characteristics similar?

Yes (low risk)

No (high risk)

Unclear

Note whether baseline characteristics were reported and whether there were any important differences between groups. 

Were incomplete outcome data adequately addressed?

Assessments should be made for each main outcome (or for class of outcomes)

Yes (low risk)

No (high risk)

Unclear

Describe the completeness of outcome data for each main outcome, including attrition and exclusions from the analysis. State whether attrition and exclusions were reported, the numbers in each intervention group (compared with total randomized participants), reasons for attrition/exclusions where reported, and any re-inclusions in analyses performed by review authors. 

Was knowledge of the allocated intervention adequately prevented during the study?

Separate assessments should be made for relevant groups of people involved in the study (participants, outcome assessors, investigators, data assessors, etc)

Yes (low risk)

No (high risk)

Unclear

Describe all measures used, if any, to blind study participants and personnel from knowledge of which intervention a participant received. Provide any information relating to whether the intended blinding was effective, or whether blinding was appropriate.

  • Participants – yes (low risk), no (high risk), unclear (record supporting statement from study)

  • Investigators – yes (low risk), no (high risk), unclear (record supporting statement from study)

  • Outcomes assessors - yes (low risk), no (high risk), unclear (record supporting statement from study)

  • Data assessors - yes (low risk), no (high risk), unclear (record supporting statement from study)

 
Was the study adequately protected against contamination?

Yes (low risk)

No (high risk)

Unclear

State whether and how the possibility of contamination was minimized by the study design/implementation. 

Are reports of the study free of suggestion of selective outcome reporting?

Assessments should be made for each main outcome (or class of outcomes)

Yes (low risk)

No (high risk)

Unclear

State how the possibility of selective outcome reporting was examined by the review authors, and what was found. 
Other sources of bias

Yes (low risk)

No (high risk)

Unclear

State any important concerns about bias not addressed in the other domains in the tool. 
 Interrupted time series (ITS) studies
ITS: Was the intervention independent of other changes?

Yes (low risk)

No (high risk)

Unclear

Describe whether or not the intervention occurred independently of other changes over time and whether or not the outcomes may have been influenced by other confounding variables/historic events during the study period.

 

 
ITS: Was the shape of the intervention effect pre-specified?

Yes (low risk)

No (high risk)

Unclear

State whether or not the point of analysis was the point of intervention. If not, describe whether a rationale for the shape of the intervention effect was given by the study authors.

 

 
ITS: Was the intervention unlikely to affect data collection?

Yes (low risk)

No (high risk)

Unclear

Describe whether or not the intervention was likely to affect data collection and what the potential impact might have been. 

ITS: Was knowledge of the allocated interventions adequately prevented during the study?

Separate assessments should be made for relevant groups of people involved in the study (participants, outcome assessors, investigators, data assessors, etc)

Yes (low risk)

No (high risk)

Unclear

Describe all measures used, if any, to blind study participants from knowledge of which intervention a participant received. Provide any information relating to whether the intended blinding was effective, or whether blinding was appropriate.

 

  • Participants – yes (low risk), no (high risk), unclear (record supporting statement from study)

  • Investigators – yes (low risk), no (high risk), unclear (record supporting statement from study)

  • Outcomes assessors - yes (low risk), no (high risk), unclear (record supporting statement from study)

  • Data assessors - yes (low risk), no (high risk), unclear (record supporting statement from study)

 

ITS: Was incomplete outcome data adequately addressed?

Assessments should be made for each main outcome (or class of outcomes).

Yes (low risk)

No (high risk)

Unclear

Describe the completeness of outcome data for each main outcome, including attrition and exclusions from the analysis. State whether attrition and exclusions were reported, the numbers in each intervention group (compared with total randomized participants), reasons for attrition/exclusions where reported, and any re-inclusions in analyses performed by the review authors. 
ITS: Was the study free from selective reporting?

Yes (low risk)

No (high risk)

Unclear

State how the possibility of selective outcome reporting was examined by the review authors, and what was found. 
ITS: Was the study free from other risks of bias?

Yes (low risk)

No (high risk)

Unclear 

State any important concerns about bias not addressed in the other domains in the tool. 

 

Contributions of authors

Draft protocol: DCB, MLL, MB, SV

Select studies: DCB, MLL

Extract data from studies: DCB, MLL

Enter data into RevMan: DCB, MLL

Carry out the analysis: DCB, MLL, MB

Interpret the analysis: DCB, MLL, MB, SV

Draft the final review: DCB, MLL, MB, SV

Resolve disagreements: SV, MB

Update the review: DCB

Declarations of interest

None known

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • National Health and Medical Research Council and The Victorian Health Promotion Foundation, Australia.

    The editorial processes of the Cochrane Public Health Group is supported by funding from the National Health and Medical Research Council and the Victorian Health Promotion Foundation

Ancillary