Reviewer's report
Title:The Economic Consequences of Reproductive, Maternal, Newborn, and
Child Health Interventions in Low- and Middle-Income Countries: A Systematic
Literature Review
Version:1Date:18 November 2014
Reviewer: Jolene Skordis-Worrall
Reviewer's report:
Thank you for the opportunity to review this interesting paper. This review has
the potentially to make a very significant contribution to knowledge however, in
its current form, the lack of a clear focus on one form of intervention or even one
form of economic benefit, makes it difficult to pull out a clear message or a useful
set of findings. I would suggest that the authors consider some of my
suggestions below and attempt a narrower focus in order to improve the
usefulness of this interesting review even further.
Major compulsory revisions
1) RMNCH or maternal and early childhood nutritional interventions to reduce
under 5 malnutrition?
• The title promises more than the paper delivers. In fact the title promises a very
broad literature review that is almost impossible to rigorously deliver in one paper
– please change the title to reflect the much more focussed (and no less useful)
content of the paper.
• The background refers to malnutrition, cognition and productivity – this is not
reflected in the search strategy and focus of the review. Reproductive, maternal,
newborn and child health (RMNCH) interventions include a large number of
interventions that will have no effect on nutrition or cognition.
• This is an ongoing tension in this paper; the conceptual framework – in so far as
there is one for the paper – refers to the economic gains of nutritional
interventions for pregnant mothers and babies but the search terms do not reflect
this focus. There is a significant lack of consistency in the ‘fit’ between the
methods and the message.
• The breadth of the programs (and outcomes) ultimately reported in the findings
is so wide that it is almost uninstructive: access to family planning versus
micro-nutrient supplementation? Is this a sensible policy trade-off? These
interventions are likely to be compliments rather than substitutes. A clearer and
more consistent focus on 1 form of intervention with a single outcome
comparable between countries would make this a more useful contribution to
knowledge.
2) Please make it clearer that there is a strong evidence base for this question in
high income countries, however the evidence base for lower income countries is
less well established. This is the main contribution of this paper and it is
important to reflect briefly on why LMIC contexts are not different in a trivial way
from HICs, for example: fewer income earning opportunities in lower income
countries may reduce the wage effect. This in turn should raise questions about
whether increases in earned income is the correct metric to use when measuring
the longer term productivity gains in low/middle income countries. It may also go
some way to explaining the gender skew in your findings.
Minor compulsory revisions
• Could the universally positive findings indicate publication bias? This possibility
requires some reflection.
• The meaning of this sentence (starting on line 61) is very unclear: “To put this in
context, as poverty reduction interventions, microfinance and conditional cash
transfer program participation increases consumption by up to 18% and 7%,
respectively, depending on the context.”
• Please avoid this shorthand notation in the text of papers: #
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests