Community-Based Interventions for Reducing Neonatal Mortality in Low-Resource Settings: A Scoping Review and Evidence Gap Map

Background Neonatal mortality disproportionately affects sub-Saharan Africa and South Asia, where facility-based care alone often misses vulnerable populations. Consequently, community-based interventions are widely advocated. However, the breadth, quality, and certainty of the supporting evidence lack comprehensive mapping. This study maps the evidence landscape for community-based neonatal mortality interventions to identify critical research gaps. Methods Following JBI scoping review and EPPI-Centre Evidence Gap Map standards, we searched OpenAlex, CrossRef, and Semantic Scholar via Python 3.12, supplemented by grey literature. A purposive, citation-informed corpus of 200 high-impact studies was selected. Quality was assessed using Cochrane RoB 2 (11 RCTs), ROBINS-I (17 non-randomised studies), AMSTAR-2 (4 systematic reviews), CASP (2 qualitative), and a Quality Indicators Checklist (166 non-evaluative studies). High heterogeneity precluded meta-analysis; data were narratively synthesized and evidence certainty assessed using GRADE criteria. Results Community health worker (CHW) programmes, participatory women’s groups, and essential newborn care (ENC) were evaluated most frequently. Methodological quality was mixed: all 11 RCTs showed "some concerns" (RoB 2) and all 17 non-randomised studies indicated "moderate risk" (ROBINS-I). Consequently, GRADE certainty for RCT-derived outcomes was very low to moderate, downgraded primarily for indirectness, inconsistency, and imprecision. Narratively, women's groups, CHW home visits, and ENC most consistently reduced mortality. Geographically, within this highly cited corpus, West Africa was substantially underrepresented relative to its severe disease burden. Conclusions Moderate-certainty evidence, predominantly from South Asian cluster RCTs, supports the mortality-reducing benefits of specific community packages. However, this geographically skewed and heterogeneous evidence base precludes strong causal conclusions for West African settings, though regional literature may exist outside the queried databases. This review highlights profound gaps in highly cited, rigorous evidence for high-burden regions, emphasizing the need for equitable research investment and the application of advanced causal and adaptive study designs (e.g., quasi-experiments, micro-randomized trials) to guide local policy.