PROTOCOL: Megamap of systematic reviews and evidence and gap maps on the effectiveness of interventions to improve child well‐being in low‐ and middle‐income countries

Child well‐being is a multidimensional and a holistic concept which provides a contextual understanding of a child in different domains such as health, material well‐being, education, conditions of housing and environment, and interpersonal relations (UNICEF, 2014). A decent level of child well‐being is underpinned by the Declaration of the Rights of the Child which states that “The child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth” (Cohen, 1989). But many children around the world still suffer deficiencies in many dimensions of well‐being.


| Consequences of shortfalls in child well-being
Childhood deprivation cannot just take childhood from children, but also have long-run consequences. Child undernutrition is associated with shorter adult height, less schooling, reduced economic productivity and lower offspring birthweight for women (Victora et al., 2008). Lack of education is a major factor in households remaining poor (Baulch, 2011). Early marriage is bad for the health of the motherwith greater risk of dying during childbirthand her offspring who are at greater risk of having low birth weight and of dying prematurely (Nour, 2006).

| Addressing shortfalls in child well-being
The provision of services on health, education and safety to all children in the world irrespective of cast, creed, colour and ethnicity is a fundamental right enshrined in the UN Convention on the Rights of the Child.
In recognition to the 2030 Agenda for Sustainable Development, children's rights and well-being are acknowledged as important for long-term sustainable development of children. Some sustainable development goals (SDGs) are important reference points for the design of national development strategies for child well-being such as: end poverty (SDG1), end hunger, achieve food security and improved nutrition and promote sustainable agriculture (SDG2), health (SDG 3), quality education (SDG4), reduce inequality between and within countries (SDG10).
Despite this apparent focus on child well-being and various international organisations working toward a common goal, striking gaps remains in achieving SDG indicatorsas outlined above.
Research can play a crucial role in helping to close the remaining gaps in global evidence base for effective interventions. SDG 17 targets 17.16 and 17.18 emphasises increased need for investment in generating sound evidence to improve child well-being interventions strategies. Though child well-being interventions have been in use for decades; however, evidence for the effectiveness of these interventions are often scattered, their value is possibly underestimated and their inclusion in national strategies and programmes is rare.
Failure to effectively implement evidence informed interventions represents a key obstacle in the progress of child well-being system in many low and middle income countries (LMICs) toward achieving the United Nations SDGs. This is partly due to a weak and underutilised evidence base that does not give policy makers and programme managers the information needed to make decisions.
Both international and national organisations should work together to fill the gaps in evidence and to gain a better understanding of what works and what doesn't in child well-being.

| Why it is important to develop the Megamap
Evidence-based research and multi-country experiences make a strong rationale for investing in child well-being programmes. While evidence-based policy making is of increasing importance, many agencies commission systematic reviews to inform policy, but due to lack of a central repository, systematic reviews are often duplicated and may give misleading findings if not undertaken to proper standards. Also, the existing evidence base around child well-being has major gaps. Even the existing research is rarely accessed or used for policy or funding decisions as studies are often scattered across different databases and website.
Evidence maps are an approach to providing an overview of the available evidence, with various approaches adopted to evidence mapping by different agencies over the years (Saran & White, 2018).
There has been a rapid growth in evidence and gap maps (EGMs) in recent years, notably in international development (Phillips et al., 2017). A typical EGM provides an overview of primary studies and systematic reviews in a particular policy domain. Since this map has such a broad scopeall of child well-beingwe label it as a Megamap and map only systematic reviews and EGMs.
Based on a systematic search, the proposed Megamap will provide an overview of the evidence of the effectiveness of interventions aimed at improving child well-being in LMICs using an intervention-outcome framework. It will identify areas in which there are good bodies of synthesised knowledge to inform policy, and those areas in which there is little or no evidence synthesis. The map will contain effectiveness studies. It does not include other research on child well-being, including qualitative studies.
The map will inform the identification of priority areas where evidence is currently lacking, such as rigorous systematic reviews of the effectiveness of early marriage interventions, child labour or those in conflict-affected situations. This will help create a central repository of all the available resource on the effectiveness of child well-being.
UNICEF Innocenti centre with Campbell Collaboration has published a set of five research briefs highlighting main findings of a preliminary version of the Megamap. As a next step, the two organisations are now working on an evidence and gap on child violence in LMICsidentified in the draft Megamap as an area deficient in evidence synthesis.

| Scope of the Megamap
The Megamap will include existing EGMs and systematic reviews which synthesise evidence of the effectiveness of child well-being interventions in improving child well-being. The map will be presented in two dimensions: the rows list interventions and subcategories, and the columns the outcome domains. Each cell shows systematic reviews and EGMs which contain evidence on that combination of intervention and outcome. Included systematic reviews and EGMs are coded for additional characteristics which can be used in filters, such as country, region and child categories.
We started developing draft the framework by reviewing UNICEF strategy documents, key documents by major funders as WHO, UNDP, DFID, Save the Children and World Bank to name a few. In particular we referred to UNICEF strategic plan 2018-2021: Executive summary (UNICEF Research Brief, 2018) and Global Strategy for Women's and Children's health (Ki-Moon, 2010). Various stakeholder consultations were carried out to refine the framework.
The final framework aimed to provide an overview of existing systematic reviews for child welfare interventions as 1. Early childhood interventions that addressed the period from pregnancy, child birth and children up to 3 years of age.
2. Health and nutrition that addressed maternal health interventions, timing and spacing of birth, child birth, nutrition, prevention and treatment of childhood diseases.
3. Educational intervention that aimed to address improve learning and achievement and skill development of children from 4 to 18 years of age.
4. Social work and welfare that aimed to protect the child from violence and other risk factors.
5. Social protections interventions that aimed to provide financial support to mother, children and families to access the basic amenities for survival and living.
6. Environmental WASH to ensure every child lives in clean environment.
7. Governance and advocacy to ensure sustainable intervention strategies.
1.6 | Conceptual framework of the EGM Figure 1 below illustrates how child welfare interventions may help contribute to achieving UNICEF strategic goals outcomes.

| Existing EGMs and/or relevant systematic reviews
Since this a Megamap and has a very broad scope, it will be first of its kind in this area. But there are related EGMs that will be included in the Megamap. Examples include 1. EGM on social, behaviour and community engagement intervention produced by World Health Organisation and International Initiative of Impact Evaluation (3ie) presents the evidence available on social, behavioural and community engagement interventions related to reproductive, maternal, newborn and child health programmes in LMICs.
F I G U R E 1 Conceptual framework for the child well-being Megamap Source: Author's own design 2. EGM on primary and secondary education by 3ie that presents evidence on interventions designed to improve access to education and learning outcomes for primary and secondary school children in LMICs.
3. EGM on Intimate partner Violence highlights important gaps in the rigorous evidence base of intimate partner violence prevention programmes in LMICs.
There are number of focussed reviews related to specific child well-being interventions such as  3. Another systematic review by Bright, Felix, Kuper and Polack (2017) measures effectiveness of interventions aimed at increasing access to health services for children aged 5 years and below in LMIC.

| Objectives
The specific objectives are 1. Develop a clear taxonomy of interventions and outcomes related to the effectiveness of child well-being interventions aimed at improving child well-being in LMICs.
2. Map available systematic reviews and EGMs of the effectiveness of interventions aimed at improving child well-being in LMICs with an overview provided in a summary report.

Provide database entries of included systematic reviews and
EGMs which summarise the intervention, context, study design and main findings.

| Defining EGMs
This EGM is an effectiveness map in which the primary dimensions are the rows and columns of the map which are, respectively, intervention categories (and sub-categories) and indicator domains (and sub-domains). Secondary dimensions, such as country and target group will be included as filters.

| Population
The primary population of interest for this Megamap is children under the age of 18 years as per the definition by United Nation Convention and includes children from LMICs. LMICs are defined by World Bank as low-income economiesthose with a Gross National Income (GNI) less than $995; lower middle-income economiesthose with a GNI per capita between $996 and $3,895; and upper middle-income economiesthose with a GNI per capita between $3,896 and $12,055 (World Bank, 2018). Different child age ranges (0-1 month, 1 month-2 years, 2-6 years, 6-12 years and 12-18 years).
Population sub-groups of interest include: orphans, children with disabilities, children belonging to ethnic minorities, child sex workers, malnourished children, child brides, isolated children/street child, children with HIV/AIDS and children in conflict and humanitarian settings.

| Interventions
The included interventions cover all main strategies whose primary purpose is to improve child well-being outcomes. So we do not include more general policies (e.g., macroeconomic policies) which will affect child well-being, or more general social programmes (such as health or unemployment insurance). Many of the included interventions are directly targeted at children, for example, immunisation or education interventions. But that is not necessarily the case. For example, parenting programmes intended to modify parenting practice and a community-based campaign against early marriage attempts to modify social normsbut in both cases with the end goal of improving child well-being.  Table 2 lists the outcome categories and sub-categories. These are broad sub-categories, and the recorded outcomes may be even positive or negative effects.

| Types of study designs
The Megamap will include only systematic reviews and EGMs of effects of interventions. The key characteristics for a review to be included as a 'systematic review' 1. A clearly stated set of objectives with pre-defined eligibility criteria for studies.

A systematic search that attempts to identify studies that would
meet the eligibility criteria. 4. A systematic presentation, and synthesis, of the characteristics and findings of the included studies.
Studies were not excluded based on the results of our critical appraisal of the included studies.

| Treatment of qualitative research
The map will not include qualitative research.

| Types of settings
Systematic reviews will be from LMICs. Systematic reviews that have a global focus will be excluded if their focus is predominantly on highincome countries. Those which contain information on high-, middleor low-income countries, but where the findings are clearly disaggregated by region or country and where the findings for lowor middle-income regions or countries are presented separately will also be included.
EGMs that included studies from LMICs were included even if they had global focus.

| Status of studies
On-going systematic reviews and EGMs will be included. Status of systematic reviews and EGMs will be a filter.

| Screening and selection of studies
All titles and abstracts, and then full text, will be double screened, with a third party arbitrator in the event of disagreement.

| Data extraction, coding and management
Coding will be done independently by two coders, with a third party arbitrator in the event of disagreement. The coding form is given in Annexure B. The coding form is very straightforward so coding is conducted in Excel.

| Quality appraisal of systematic reviews
The quality of the included systematic reviews will be assessed using AMSTAR 2.
Critical appraisal will not be carried out for included EGMs.
2.11 | Analysis and presentation 2.11.1 | Unit of analyses Each entry in the map will either be a systematic review or and EGM. The accompanying EGM report will identify the number of systematic reviews and EGMs covered by the map in each sector.

| Presentation
The map will be generated using the EPPI Centre's Mapping Software.
In addition to intervention and outcomes, the following filters will be coded systematic reviews and Megamap: ( Filters 2 and 4 are applied if the included review or map's own inclusion criteria meant such studies were eligible. As mentioned above, the population sub-group filters were applied when that was the focus of the review.

| Planned analysis
The EGM report shall provide tabulations or graphs of the number of systematic reviews and EGMs, with accompanying narrative description, by • Intervention category and sub-category • Outcome domain and sub-domain •

| Stakeholder engagement
The framework was developed through a consultative process. An advisory board was formed comprising of key experts in the area SARAN ET AL.

FUNDING
This EGM is partially supported by the UNICEF Innocenti Centre.

CONFLICT OF INTERESTS
The authors declare that there are no conflict of interests.

PRELIMINARY TIMEFRAME
Phase 1: Systematic reviews from 3ie database: completed  Target age group key words -(young child* OR children OR pre-schooler* OR pre-schoolers*, kindergarten* OR kindergartener*, early child OR childhood, and early year OR years) -("adolescen*" OR juvenile OR minors OR youth OR "young adult" OR "young women" OR "young men" OR girl* OR boy* OR (school adj6 student*) OR teen* OR schoolgirl* OR schoolboy*)

ANNEXURE B: CODING
After screening, all systematic reviews and EGM will be coded for a wide array of information and populated into the map. The coded information includes bibliographic details for the study, the interventions from the framework that the study evaluates, the outcomes from the framework that the study measures and other relevant aspects. Coding of each study will be verified by a second researcher.

Coding variable
Example of information that may be recorded opportunities for children to interact with responsive adults and actively learn with peers to prepare for primary school entry and also interventions directed on parent training.
• Health based-mother and child interventions • Parenting education/programme • Care institutions • Child-to-child programmes Women/Maternal Education and empowerment: Interventions working with the mothers and families to change parents' or caregivers' knowledge, attitudes and behaviours or to encourage dialogue on health care services and decision making by women ECD4 • Participatory action groups on Gender norms • Campaigns on maternal health education and girl child education • Couples interventions • Counselling (FP, ANC) for men and women, encourage men support • Vocational training/life skill education • Women support group on financial and gender issue Health and Nutrition (HN): A health intervention is an act performed for, with or on behalf of a person or population whose purpose is to assess, improve, maintain, promote or modify health, functioning or health conditions. Remedial education: Also known as developmental education, basic skills education, compensatory education, preparatory education, and academic upgrading is assigned to assist students in order to achieve expected competencies in core academic skills such as literacy and numeracy.

E11
Pedagogical approach:Includes how the teacher interacts with students and the social and intellectual environment the teacher seeks to establish E12 (Continues) Social work and welfare (SW):development and provision of public or private social services to promote social justice amongst individuals and groups of individuals. While the term social welfare refers more generally to the well-being of groups and individuals as well as the system of social service delivery, the term social work refers more specifically to the professional practice of delivering these social services. Governance (G): "governance can be seen as the exercise of economic, political and administrative authority to manage a country's affairs at all levels. It comprises the mechanisms, processes and institutions, through which citizens and groups articulate their interests, exercise their legal rights, meet their obligations and mediate their differences."

Birth registration SW1
Child rights: it provides a set of principles and standards coveringchildren's entitlements to such essentials as education, healthcare and the right to be heard, as well as protection fromabuses such as unjust treatment and exploitation.It places an obligation on states to ensure that all children withintheir jurisdiction (including non-citizens such as refugees) enjoy these rights G1 • Educating children on their rights • Supporting community-based legal and paralegal services for children • Child rights Monitoring • awareness of legal drafting committees on the importance of children's rights and the provisions of the UNCRC. • Provide technical assistance and training to law enforcement officials, judges, parliamentarians and others concerned with implementations • Advocate for legislative costing and appropriate resource allocation • ensuring the availability of financial and other assistance for equitable access for children and families to judicial system • Using available complaint mechanism of child right commissions in countries • Support child-led media initiatives • building the capacity of media organisations on children's rights Legislative reforms: develop and adopt national legislation to implement child protection laws.

G2
• family law • juvenile justice • laws about education • against child labour • laws to protect children from sexual exploitation • Gender quality • Non-discrimination Child protection regulation: Measures that protect access to resources, promote employment, and support the childcare role.

G3
• national budget allocation and expenditure for maternal and child services.
• Adopting national legislation for birth registration • abolishing child and bonded labour • enforcing minimum wage rates, • providing paid maternity leave • ensuring that health and safety standards are met. • Inter-agency collaboration in areas of conflicts to address child protection needs