Ishaque et al. BMC Public Health 2011, 11(Suppl 3):S3 http://www.biomedcentral.com/1471-2458/11/S3/S3 Table 4 Quality assessment of trials of interventions for infections (bacterial vaginosis) in pregnancy Quality Assessment Summary of Findings Design Limitations Consistency No of studies (ref) 4 RCTs Antibiotics for bacterial vaginosis and perinatal death: MODERATEoutcome specific quality Low recruitment response Some heterogeneity in one study, also in meta-analysis; 3/4 allocation concealment studies show benefit unclear The review employs a comprehensive search strategy thus increasing the chance of retrieving all relevant stu- dies. Mainly randomized controlled and quasi rando- mized trials have been considered that provide a high quality level of evidence. It is however important to note that data from interventional studies were scarce. A high quality research agenda addressing the contribution of infections to stillbirth, especially in developing countries, is needed to reduce stillbirths worldwide. At present, large gaps exist in the growing list of stillbirth risk fac- tors, especially those that are infection related [72]. The clearest evidence of impact on stillbirth prevention is adequate prevention and treatment of infections such as syphilis and possibly malaria. Other potential causes of stillbirth including HIV, bacterial vaginosis, ascending infections and TORCH infections need to be investigated further to help establish the role of prevention/treatment and its subsequent impact on stillbirth reduction [72]. Efficacious interventions exist for certain maternal infec- tions and conditions for which the evidence of plausible benefit is not very clear. Therefore, efforts need to be geared to conduct high quality trials for us to ascertain the full extent of the relation between interventions and their potential to reduce stillbirths. Conclusions The clearest evidence of impact in stillbirth reduction is adequate prevention and treatment of maternal infec- tions such as syphilis and possibly malaria. At present, large gaps exist in the growing list of stillbirth risk fac- tors, especially those that are infection related. Key Messages A reduction of 80% is observed in the incidence of still- births in pregnant women with syphilis receiving penicillin. Malaria prevention intervention in pregnancy through IPTp and ITNs providemay reduce stillbirths by 22% during the first or second pregnancy in areas of stable P. falciparum malaria transmission. More studies need to be conducted to determine the effectiveness of interventions for diseases such as HIV, Page 9 of 12 Odd Ratios (95% CI) OR = 0.88 (0.50 - 1.55) Directness No of events Generalizability to population of interest Generalizability Intervention Control to intervention of interest Yes Yes 23 26 ascending bacterial infections and TORCH infections for reducing stillbirths. Additional material Additional File 1: A word document containing a review of literature for specific infections related to stillbirths. Additional File 2: A word document containing the basic search strategies and terms used for specific infections.. Additional File 3: An excel file that contains the data extraction sheet of studies included in the review. Additional File 4: A word file that described the characteristics of studies included in the main meta-analysis. Acknowledgements This work was supported in part by a grant to the US Fund for UNICEF from the Bill & Melinda Gates Foundation (grant 43386) to “Promote evidence- based decision making in designing maternal, neonatal and child health interventions in low- and middle-income countries”. This article has been published as part of BMC Public Health Volume 11 Supplement 3, 2011: Technical inputs, enhancements and applications of the Lives Saved Tool (LiST). The full contents of the supplement are available online at http://www.biomedcentral.com/1471-2458/11?issue=S3. Author details 1Division of Women and Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi-74800, Pakistan. 2Drexel University College of Medicine, Philadelphia, USA. 3Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans LA, USA. Authors’ contributions Professor Zulfiqar A Bhutta developed the review parameters and secured support. Drs Sidra Ishaque, Yawar Yakoob and Aamer Imdad, undertook the literature search, data extraction and analysis with advice and input from Professor Robert Goldenberg, Dr Thomas Eisele and Professor Bhutta. Professor Zulfiqar A. Bhutta gave advice on all the aspects of the project and was the overall supervisor. Competing interests The authors declare no conflict of interests. Published: 13 April 2011 References 1. Lawn JE, Yakoob MY, Haws RA, Soomro T, Darmstadt GL, Bhutta ZA: 3.2 million stillbirths: epidemiology and overview of the evidence review. BMC Pregnancy Childbirth 2009, 9(Suppl 1):S2. 2. Goldenberg RL, McClure EM, Saleem S, Reddy UM: Infection-related stillbirths. Lancet 375(9724):1482-1490.