Types of studies and participants
Both institutional and community-based cross-sectional studies published in the English language from January 2004 to December 2019 were included. Literature was eligible for inclusion if they reported the involvement of male partners of pregnant women and nursing mothers in birth preparedness and complication readiness in (LMICs) as their study participants and/or the main outcome of the studies reported the magnitude of male partners' participation in (BP/CR) in the global south. Systematic reviews, studies conducted on women participation in BP/CR, studies found to have methodological flaws after a quality assessment and conducted in high-income countries were excluded.
Search strategy, identification, and selection of studies
The search strategy was aimed to locate both published and grey literature. An initial limited search of Google Scholar was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy for PubMed/Medline, EMBASE, CINHAL, Google Scholar, and Scopus (Appendix 1). The search strategy, including all identified keywords and index terms, were adapted for each included information source. The reference list of all studies selected for critical appraisal was screened for additional studies.
Following the search, all identified citations were organized and uploaded into EndNote version 15.0 and duplicate removed. Titles and abstracts were screened by MTB and MBS and double – checked by HT for assessment against the inclusion criteria for the review. Potentially relevant studies were retrieved in full including their citation details. The full text of selected citations was assessed in detail against the inclusion criteria by MTB and MBS and double – checked by HT and MY. Reasons for exclusion of full-text studies that do not meet the inclusion criteria were recorded and reported in the systematic review. Any disagreements that arise between the reviewers at each stage of the study selection process were resolved through discussion, or with a third reviewer. The results of the search were reported in full in the final systematic review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram (Fig 1).
Definition of BPCR: Birth Preparedness and Complication Readiness (BP/CR) is a strategy to support the active use of trained maternal and neonatal care, especially during childbirth, based on the theory that arranging for childbirth and being prepared for complications decreases delays in receiving this care. Whereas male partner participation in BP/CR refers to the active involvement in the health care services delivery uptake by the male partner of pregnant women and nursing mother within the 42 days of the delivery of the neonate[40, 41].
Data collection, data synthesis, and analysis
The authors jointly prepare and determined the data extraction tool for this study.
The data were extracted from primary studies included in the review using the data extraction tool prepared by two independent reviewers. The tool includes variables such as the name of the author, publication year, study design, data collection period, sample size, study area, participants, response rate, and prevalence of birth preparedness and complication readiness. Additionally, the tool contains information on; the percentage of women who saved money for birth and emergency case, women who prepared blood donor, women who identified skilled birth attendant, women who were aware of danger signs during pregnancy, women who arranged transportation, women who identified the place of birth and women who planed health facility delivery. All authors involved in the data extraction. Any disagreements that arise between the reviewers were resolved through discussion, or with a third reviewer. Authors of papers were contacted to request missing or additional data if needed.
Included studies were pooled in a statistical meta-analysis using version 14. Effect sizes were expressed as a proportion with 95% confidence intervals around the summary estimate. Heterogeneity was assessed statistically using the standard chi-square I2 test. A random-effects model using the double arcsine transformation approach was used. Sub-group analyses were conducted to investigate the level of male partner participation in the Sub-Saharan African and Asian regions. Sensitivity analyses were conducted to test decisions made regarding the included studies.
Assessment of risk of bias and methodological quality
Eligible studies were critically appraised by two independent reviewers at the study level for methodological quality in the review using standardized critical appraisal instruments from the Joanna Briggs Institute for incidence and prevalence. Authors of papers were contacted to request missing or additional data for clarification, where required. Any disagreements that arise were resolved through discussion, or with a third reviewer. The results of the critical appraisal were reported in narrative form and a table and lower risk of bias (64.2) observed after assessment (Table 2). Following the critical appraisal, studies that do not meet a certain quality threshold were excluded. This decision will be based on inadequate sample size, inappropriate sampling frame, and data analysis conducted with sufficient coverage of the identified sample. Articles were reviewed using titles, abstracts, and full review. Studies that did not meet inclusion criteria were excluded. Full texts of included studies were examined using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) for critical appraisal (Table 2).