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Spillover effects on health outcomes in low- and middle-income countries: a systematic review.

Abstract：

Background:Many interventions delivered to improve health may benefit not only direct recipients but also people in close physical or social proximity. Our objective was to review all published literature about the spillover effects of interventions on health outcomes in low-middle income countries and to identify methods used in estimating these effects. Methods:We searched 19 electronic databases for articles published before 2014 and hand-searched titles from 2010 to 2013 in five relevant journals. We adapted the Cochrane Collaboration's quality grading tool for spillover estimation and rated the quality of evidence. Results:A total of 54 studies met inclusion criteria. We found a wide range of terminology used to describe spillovers, a lack of standardization among spillover methods and poor reporting of spillovers in many studies. We identified three primary mechanisms of spillovers: reduced disease transmission, social proximity and substitution of resources within households. We found the strongest evidence for spillovers through reduced disease transmission, particularly vaccines and mass drug administration. In general, the proportion of a population receiving an intervention was associated with improved health. Most studies were of moderate or low quality. We found evidence of publication bias for certain spillover estimates but not for total or direct effects. To facilitate improved reporting and standardization in future studies, we developed a reporting checklist adapted from the CONSORT framework specific to reporting spillover effects. Conclusions:We found the strongest evidence for spillovers from vaccines and mass drug administration to control infectious disease. There was little high quality evidence of spillovers for other interventions.

journal_name

Int J Epidemiol

journal_title

International journal of epidemiology

authors

Benjamin-Chung J,Abedin J,Berger D,Clark A,Jimenez V,Konagaya E,Tran D,Arnold BF,Hubbard AE,Luby SP,Miguel E,Colford JM Jr

doi

10.1093/ije/dyx039

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

1251-1276

issue

eissn

0300-5771

issn

1464-3685

pii

3752464

journal_volume

pub_type

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Spillover effects on health outcomes in low- and middle-income countries: a systematic review.