Methodological Assessment of Quasi-Experimental Designs in Rural Clinics Systems in Kenya: A Systematic Literature Review

Quasi-experimental designs are increasingly used in healthcare research to evaluate interventions in resource-limited settings such as rural clinics in Kenya. A comprehensive search strategy was employed using databases like PubMed and Cochrane Library. Eligible studies were screened based on predefined criteria including the use of quasi-experimental designs to evaluate rural clinic systems in Kenya. Methodological quality assessment used a validated tool (e.g., ROBIS) for grading. The review identified a trend towards overuse of single-group pre-post designs without appropriate controls, which can lead to biased estimates of intervention effects. Mixed-method studies were found to offer more robust insights into complex system interventions. Methodological deficiencies in quasi-experimental designs for rural clinics systems pose significant challenges for valid and reliable evaluations of clinical outcomes. Enhanced methodological rigor is recommended, including the use of multiple-group pre-post designs with appropriate controls, to improve the validity of findings. Mixed-method approaches are encouraged to provide a more comprehensive understanding of system interventions. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.