Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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PloS one
Uptake and determinants of immediate and extended postpartum long-acting reversible contraceptive use in Eastern and Western Africa: A systematic review and meta-analysis
BACKGROUND: Reducing unintended pregnancies and improving maternal/child health relies heavily on postpartum family planning (PPFP). Despite their high effectiveness, the use of long-acting reversible contraceptives (LARC), such as intrauterine contraceptive device (IUCD) and implants, is inconsistent in Africa after childbirth. This systematic review and meta-analysis aimed to assess the prevalence and determinants of immediate and extended postpartum use of long-acting reversible contraceptives in Eastern and Western Africa. METHODS: We searched PubMed, the Cochrane Library, Hinari, and gray literature sources (Google Scholar) for studies published between January 1, 2015, and December 12, 2025. Eligible studies reported LARC uptake within 12 months of postpartum. Heterogeneity was assessed using the I² statistic, publication bias using Egger's test, and study quality using the JBI 2020 checklist. Data were analyzed using Stata version 17 and R version 4.5. RESULTS: Sixty-eight studies were included, most of which were from Eastern Africa. The pooled prevalence was 21.7% for immediate postpartum LARC (IPP-LARC) and 19.5% for extended postpartum LARC (EPP-LARC). Uptake was significantly associated with counseling during maternal and child health visits, partner involvement, prior family planning use, and good knowledge. Age ≥ 35 years and higher education level also favored immediate postpartum IUD use. CONCLUSION: The uptake of postpartum LARCs remains low in Eastern and Western Africa. Strengthening FP counseling during MCH services, encouraging partner involvement, and improving knowledge are critical strategies to increase coverage and reduce unmet needs. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews (ID: CRD420250577642).
19 Apr 2026
Read appraisal →African journal of reproductive health
Effects of Simulation-Based Mastery Learning versus Deliberate Practice on midwifery students' knowledge, skills and self confidence in managing the third stage of labour: A quasi-experimental study
Achieving maternal health care coverage by 2030 requires strengthening the midwifery workforce. To ensure accessible, culturally appropriate, and high-quality care, midwives must receive education aligned with global standards. This study aimed to evaluate the effect of a 20 hours Simulation-Based Mastery Learning (SBML) combined with Deliberate Practice (DP) and the Objective Structured Clinical Examination (OSCE) on midwifery students' knowledge, skills, and self-confidence in managing the third stage of labor. Sixty midwifery students were randomly allocated to experimental (n = 30) and control (n = 30) groups. Following the intervention, all students met or surpassed the minimum passing standard (MPS), achieving at least 90% in skills (Z=-4.791; p<.001; r~0.87), 80% in knowledge (Z=-4.814; p<.001, r~0.87 ), and an increased score in self-confidence (Z=-4.792; p<.001; r~0.87 ). These improvements were maintained after the clinical experience. The performance of students trained through the traditional approach was significantly lower than that of those trained with SBML, and none of them achieved the MPS. This study highlights the need to structure nursing and midwifery training programs according to the Theory-SBML-Clinical placement model to strengthen students' competencies. La réalisation de la couverture universelle des soins de santé maternelle d’ici 2030 passe par un renforcement substantiel de la profession de sage-femme. Pour assurer des soins accessibles, culturellement adaptés et de qualité optimale, il est essentiel que les sages-femmes bénéficient d’une formation conforme aux normes internationales. Cette étude avait pour objectif d’évaluer l’impact de 20 heures d’apprentissage par simulation fondé sur la pédagogie de la maîtrise, la pratique délibérée, et l’Examen Clinique Objectif Structuré (ECOS) sur les connaissances, les compétences et la confiance en soi des étudiantes sages-femmes dans la prise en charge de la troisième phase de l’accouchement. Un total de 60 étudiantes sages-femmes ont été réparties de façon aléatoire en un groupe expérimental (n = 30) et un groupe témoin (n = 30). À la suite de l’intervention, toutes les étudiantes ont atteint ou dépassé la norme minimale de réussite (MPS), obtenant au moins 90 % en compétences (Z=-4.791; p<.001 ; r~0.87), 80% en connaissances (Z=-4.814; p<.001 ; r~0.87), ainsi qu’une amélioration de leur score de confiance en soi (Z=-4.792; p<.001 ; r~0.87). Ces progrès ont été conservés après l’expérience clinique. Les performances des étudiantes formées selon l’approche traditionnelle étaient significativement inférieures, et aucune d’entre elles n’a atteint le Seuil Minimal de Réussite (SMR). L’apprentissage par maîtrise, la pratique délibérée et l’ECOS apparaissent comme des éléments essentiels au développement d’un programme de formation par simulation de haute qualité, favorisant un transfert efficace des acquis vers la pratique clinique.
15 Apr 2026
Read appraisal →Journal of medical Internet research
Using Group Chats to Drive Behavior Change in Digital Health Interventions: Scoping Review and Realist Synthesis
BACKGROUND: Group chats on platforms such as WhatsApp (Meta Platforms, Inc), WeChat (Tencent Holdings Limited), and Telegram (Telegram FZ-LLC) are central to everyday communication in many settings, including across low- and middle-income countries and among groups often overlooked by one-to-one or app-based digital health tools. Yet their roles and underlying mechanisms as intentionally designed health interventions have not been comprehensively examined. OBJECTIVE: This scoping review with realist synthesis aimed to map the characteristics and reported outcomes of group chat-based health interventions and contextual conditions shaping their outcomes. It mapped intervention characteristics and identified context-mechanism-outcome (CMO) configurations driving behavior change. METHODS: We included empirical studies in which group chats were the primary digital component of the health intervention. Searches of PubMed, Embase, MEDLINE, Web of Science, and Scopus (2005-2026) and reference screening identified eligible studies. Data were extracted on study characteristics, health domains, settings, participants, platform, intervention features, and outcome domains. For the realist synthesis, CMO configurations were analyzed using reflexive thematic analysis informed by social cognitive theory and synthesized into a final program theory. RESULTS: Eighty-one studies were included. Publications increased sharply after 2020, with evidence clustering in mental health (25/81, 30.9%) and maternal and child health (20/81, 24.7%). Most studies enrolled adult participants, including pregnant or postpartum women, caregivers, and people managing chronic conditions. WhatsApp (38/81, 46.9%) and WeChat (21/81, 25.9%) were the most frequently studied platforms. Interventions were commonly delivered in clinical or community settings and typically involved mixed membership groups that included health professionals alongside participants (68/81, 84.0%). The realist synthesis identified 12 recurring CMO configurations across 5 domains: capability and actionability, confidence and motivation, modeling and norms, safe and supportive environment and access, and self-regulation and maintenance. These mechanisms were activated or suppressed by facilitation quality, group composition, cultural alignment, technological access, and social norms. The final program theory depicts group chats as dynamic systems where access, facilitation, and group structure shape how the domains amplify or dampen one another, explaining shifts from low engagement to high trust spaces sustaining behavior change. CONCLUSIONS: This review integrates descriptive mapping of interventions with realist program theory to explain how context and facilitation activate mechanisms of change, unlike prior reviews that have focused narrowly on effectiveness of digital modalities. This dual approach provides a practical, mechanism-focused basis for designing and scaling group chat interventions in practice, particularly given their potential as a low-cost, high-reach strategy embeddable within broader digital health programs. Realizing this potential depends on treating group chats as purposefully designed social environments, with deliberate attention to facilitation quality, equity-oriented access, and alignment between group structure, norms, and communication practices.
14 Apr 2026
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