Interventions for enhancing child survival practices among caregivers of under-five children in Sub-Saharan Africa: a scoping review.

Abstract

<h4>Background</h4>Child survival is a significant public health concern, especially in low and middle-income countries. Understanding the effectiveness and scope of interventions applied hitherto, in terms of quality, is crucial for developing strategies to reduce under-five mortality.<h4>Objective</h4>This scoping review aimed to identify interventions implemented to promote child survival practices among mothers and caregivers of children under five, as well as their outcomes.<h4>Method</h4>The review used Arksey and O'Malley's methodological framework and adhered to PRISMA-ScR for transparency and rigour. Sub-Saharan African studies published between 2014 and 2024 were searched using electronic databases such as PubMed, Cochrane Library, Web of Science, and Scopus.<h4>Result</h4>The study analyzed 32 studies and found that most were conducted in Ethiopia and Kenya (21.9% respectively). Some others were conducted in Ghana and Malawi (12.5% respectively), Tanzania (9.4%), Nigeria and Uganda (6.3% respectively), and Zambia (3.1%). In terms of study design, cluster randomized controlled trials were most commonly used (31.3%), followed by comparative or experimental interventions (18.8%) and randomized controlled trials (6.3). Merely five (15.6%) studies explicitly utilized a theoretical or conceptual framework to inform the design, execution, or assessment of their interventions. Community-based communication for behaviour change including interpersonal communication, and home visits were the most frequently deployed intervention strategies (56.3%). Media-based approaches (radio, mobile, SMS), nutrition-sensitive agriculture, and Water, Sanitation, and Hygiene (WASH) interventions were each featured in 18.8% and 15.6% of studies, respectively, while health facility- and group-based approaches were the least common (9.4%). The most frequently measured outcome focused on maternal and child health service uptake (25.0%), followed by child growth and development (15.6%), and hygiene and WASH-related behaviours (12.0%). Vaccination demand was the least studied outcome, reported in only one study (3.1%). These findings highlight the prevailing outcomes in improving child health and survival through community health promotion.<h4>Conclusion</h4>Community-based communication for behaviour change, including interpersonal communication and home visits, was the most commonly employed intervention in improving child survival practices among caregivers.