AimsThe association between progestin-only contraceptive (POC) use and the risk of various cardiometabolic outcomes has rarely been studied. We performed a systematic review and meta-analysis to determine the impact of POC use on cardiometabolic outcomes including venous thromboembolism, myocardial infarction, stroke, hypertension and diabetes.Methods and resultsNineteen observational studies (seven cohort and 12 case–control) were included in this systematic review. Of those, nine studies reported the risk of venous thromboembolism, six reported the risk of myocardial infarction, six reported the risk of stroke, three reported the risk of hypertension and two studies reported the risk of developing diabetes with POC use. The pooled adjusted relative risks (RRs) for venous thromboembolism, myocardial infarction and stroke for oral POC users versus non-users based on the random effects model were 1.06 (95% confidence interval (CI) 0.70–1.62), 0.98 (95% CI 0.66–1.47) and 1.02 (95% CI 0.72–1.44), respectively. Stratified analysis by route of administration showed that injectable POC with a RR of 2.62 (95% CI 1.74–3.94), but not oral POCs (RR 1.06, 95% CI 0.7–1.62), was associated with an increased risk of venous thromboembolism. A decreased risk of venous thromboembolism in a subgroup of women using an intrauterine levonorgestrel device was observed with a RR of 0.53 (95% CI 0.32–0.89). No effect of POC use on blood pressure was found, but there was an indication for an increased risk of diabetes with injectable POCs, albeit non-significant.ConclusionsThis systematic review and meta-analysis suggests that oral POC use is not associated with an increased risk of developing various cardiometabolic outcomes, whereas injectable POC use might increase the risk of venous thromboembolism.

The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, for whom, why and at what cost. We believe that high-quality and policyrelevant evidence will make development more effective and improve people's lives. 3ie evidence gap maps 3ie evidence gap maps (EGMs) are thematic collections of information about impact evaluations or systematic reviews that measure the effects of international development policies and programmes. The maps present a visual overview of existing and ongoing studies in a sector or sub-sector in terms of the types of programmes evaluated and the outcomes measured. EGM reports provide all the supporting documentation for the maps themselves, including the background information for the theme of the map, the methods and results, including the protocols and the analysis of the results. 3ie EGMs are available through an online interactive platform on the 3ie website that allows users to explore the studies and reviews that are included. About this evidence gap map reportThis report summarises the methods and findings of an EGM on interventions that seek to improve state-society relations, which was developed by 3ie with funding from USAID and under contract with NORC at the University of Chicago. The online map can be found here.All of the content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors, Board of Commissioners, NORC, USAID or the US government. Any errors and omissions are the sole responsibility of the authors. Any comments or queries should be directed to the corresponding author, Daniel Phillips dphillips@3ieimpact.org. AcknowledgementsWe gratefully acknowledge funding of this project from the United States Agency for International Development (USAID) and the support of NORC at the University of Chicago for contract administration. We are grateful to colleagues who provided inputs at various stages of the map: Edoardo Masset, Annette Brown, Birte Snilstveit, Kristen Rankin, Jorge Hombrados, Francis Rathinam, Deepthy Menon and Diana Milena Lopez Avila. We would also like to thank the members of our advisory board: Eric Kramon, Jennifer Stuttle, Clare Mcloughlin, George Ingram and Leonard Wantchekon. We are grateful to staff at USAID and NORC at the University of Chicago who helped inform the map's development. Thanks also to all the authors who shared completed and ongoing papers and helped improve the map, as well as all those who helped by providing comments, in particular our external peer reviewer. All errors are authors' own.ii Summary BackgroundThe role of the state, the effectiveness of its institutions and its legitimacy in the eyes of its citizens are central to determining a country's prospects for stability and development. The critical importance of the state-society relationship to the global development agenda is undersco...

ObjectiveA number of promising automated behaviour change interventions have been developed using advanced phone technology. This paper reviewed the effectiveness of interactive voice response (IVR)-based interventions designed to promote changes in specific health behaviours.MethodsA systematic literature review of papers published between January 1990 and September 2017 in MEDLINE, CINAHL, Embase, PsycINFO, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. From the total of 2546 papers identified, 15 randomised control trials (RCTs) met the eligibility criteria and were included in a random effects meta-analysis. Meta-regression analysis was used to explore whether behaviour change techniques (BCTs) that were used in the interventions were associated with intervention effectiveness.ResultsMeta-analysis of 15 RCTs showed that IVR-based interventions had small but significant effects on promoting medication adherence (OR=1.527, 95% CI 1.207 to 1.932, k=9, p=0.000) and physical activity (Hedges’ g=0.254, 95% CI 0.068 to 0.439, k=3, p=0.007). No effects were found for alcohol (Hedges’ g=−0.077, 95% CI −0.162 to 0.007, k=4, p=0.073) or diet (Hedges’ g=0.130, 95% CI −0.088 to 0.347, k=2, p=0.242). In the medication adherence studies, multivariable meta-regression including six BCTs explained 100% of the observed variance in effect size, but only the BCT ‘information about health consequences’ was significantly associated with effect size (β=0.690, SE=0.199, 95% CI 0.29 to 1.08, p=0.000).ConclusionIVR-based interventions appear promising in changing specific health behaviours, such as medication adherence and physical activity. However, more studies are needed to elucidate further the combination of active components of IVR interventions that make them effective and test their feasibility and effectiveness using robust designs and objective outcome measures.

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