Dataset Information

Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia.

ABSTRACT:

Background

This is a systematic review on the effectiveness of community interventions in improving maternal health care outcomes in South Asia.

Methods

We searched electronic databases to June 2017. Randomised or cluster randomised studies in communities within rural/remote areas of Nepal, Bangladesh, India and Pakistan were included. Data were analysed as risk ratios (RR) or odds ratios (OR), and effects were adjusted for clustering. Meta-analyses were performed using random-effects and evidence quality was assessed.

Results

Eleven randomised trials were included from 5440 citations. Meta-analysis of all community interventions combined compared with control showed a small improvement in the number of women attending at least one antenatal care visit (RR 1.19, 95% CI 1.06 to 1.33). Two community mobilisation sub groups: home care using both male and female mobilisers, and education by community mobilisers, improved the number of women attending at least one antenatal visit. There was no difference in the number of women attending at least one antenatal visit for any other subgroup. There was no difference in the number of women attending 3 or more antenatal visits for all community interventions combined, or any community subgroup. Likewise, there was no difference in attendance at birth between all community interventions combined and control. Health care facility births were modestly increased in women's education groups (adjusted RR (1.15, 95% CI 1.11 to 1.20; 2 studies)). Risk of maternal deaths after 2 years (RR 0.63, 95% CI 0.24 to 1.64; 5 studies), and 3 years (RR 1.11, 95% CI 0.52 to 2.36; 2 studies), were no different between women's education groups and control. Community level mobilisation rather than health care messages at district level improved the numbers of women giving birth at health care facilities (RR1.09 (95%CI 1.06 to 1.13; 1 study)). Maternal health care knowledge scores improved in two community-based interventions, one involving education of male community members.

Conclusion

Women's education interventions may improve the number of women seeking birth at a health care facility, but the evidence is of low quality. No impact on maternal mortality was observed Future research should explore the effectiveness of including male mobilisers.

Trial registration

This systematic review is registered with PROSPERO CRD42016033201 .

SUBMITTER: Sharma BB

PROVIDER: S-EPMC6086057 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Publications

Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia.

Sharma Binod Bindu BB Jones Lisa L Loxton Deborah Joanne DJ Booth Debbie D Smith Roger R

BMC pregnancy and childbirth 20180810 1

<h4>Background</h4>This is a systematic review on the effectiveness of community interventions in improving maternal health care outcomes in South Asia.<h4>Methods</h4>We searched electronic databases to June 2017. Randomised or cluster randomised studies in communities within rural/remote areas of Nepal, Bangladesh, India and Pakistan were included. Data were analysed as risk ratios (RR) or odds ratios (OR), and effects were adjusted for clustering. Meta-analyses were performed using random-eff ...[more]

PMID: 30097022

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Project description:Aim and objectivesThis review analysed the implementation and integration into healthcare systems of maternal and newborn healthcare interventions in Africa that include community health workers to reduce maternal and newborn deaths.BackgroundMost neonatal deaths (99%) occur in low- and middle-income countries, with approximately half happening at home. In resource-constrained settings, community-based maternal and newborn care is regarded as a sound programme for improving newborn survival. Health workers can play an important role in supporting families to adopt sound health practices, encourage delivery in healthcare facilities and ensure timeous referral. Maternal and newborn mortality is a major public health problem, particularly in sub-Saharan Africa, where the Millennium Development Goals 4, 5 and 6 were not achieved at the end of 2015.MethodsThe review includes quantitative, qualitative and mixed-method studies, with a data-based convergent synthesis design being used, and the results grouped into categories and trends. The review took into account the participants, interventions, context and outcome frameworks (PICO), and followed the adapted PRISMA format for reporting systematic reviews of the qualitative and quantitative evidence guide checklist.ResultsThe results from the 17 included studies focused on three themes: antenatal, delivery and postnatal care interventions as a continuum. The main components of the interventions were inadequate, highlighting the need for improved planning before each stage of implementation. A conceptual framework of planning and implementation was elaborated to improve maternal and newborn health.ConclusionThe systematic review highlight the importance of thoroughly planning before any programme implementation, and ensuring that measures are in place to enable continuity of services.Relevant to the clinical practiceConceptual framework of planning and implementation of maternal and newborn healthcare interventions by maternal community health workers.

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Dataset Information

Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia.

Background

Methods

Results

Conclusion

Trial registration

Publications

Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia.

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