Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 2. maternal health findings

Mary Carol Jennings, Subarna Pradhan, Meike Schleiff, Emma Sacks, Paul A Freeman, Sundeep Gupta, Bahie M Rassekh, Henry B Perry, Mary Carol Jennings, Subarna Pradhan, Meike Schleiff, Emma Sacks, Paul A Freeman, Sundeep Gupta, Bahie M Rassekh, Henry B Perry

Abstract

Background: We summarize the findings of assessments of projects, programs, and research studies (collectively referred to as projects) included in a larger review of the effectiveness of community-based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH). Findings on neonatal and child health are reported elsewhere in this series.

Methods: We searched PUBMED and other databases through December 2015, and included assessments that underwent data extraction. Data were analyzed to identify themes in interventions implemented, health outcomes, and strategies used in implementation.

Results: 152 assessments met inclusion criteria. The majority of assessments were set in rural communities. 72% of assessments included 1-10 specific interventions aimed at improving maternal health. A total of 1298 discrete interventions were assessed. Outcome measures were grouped into five main categories: maternal mortality (19% of assessments); maternal morbidity (21%); antenatal care attendance (50%); attended delivery (66%) and facility delivery (69%), with many assessments reporting results on multiple indicators. 15 assessments reported maternal mortality as a primary outcome, and of the seven that performed statistical testing, six reported significant decreases. Seven assessments measured changes in maternal morbidity: postpartum hemorrhage, malaria or eclampsia. Of those, six reported significant decreases and one did not find a significant effect. Assessments of community-based interventions on antenatal care attendance, attended delivery and facility-based deliveries all showed a positive impact. The community-based strategies used to achieve these results often involved community collaboration, home visits, formation of participatory women's groups, and provision of services by outreach teams from peripheral health facilities.

Conclusions: This comprehensive and systematic review provides evidence of the effectiveness of CBPHC in improving key indicators of maternal morbidity and mortality. Most projects combined community- and facility-based approaches, emphasizing potential added benefits from such holistic approaches. Community-based interventions will be an important component of a comprehensive approach to accelerate improvements in maternal health and to end preventable maternal deaths by 2030.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest Form at www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no conflict of interest.

Figures

Figure 1
Figure 1
Number of interventions implemented in individual assessments of the effectiveness of community-based primary health care in improving maternal health.

References

    1. Randive B, Diwan V, De Costa A. India’s Conditional Cash Transfer Programme (the JSY) to promote institutional Birth: is there an association between institutional birth proportion and maternal mortality? PLoS One. 2013;8:e67452. doi: 10.1371/journal.pone.0067452.
    1. Hulton LA, Matthews Z, Stones RW. Applying a framework for assessing the quality of maternal health services in urban India. Soc Sci Med. 2007;64:2083–95. doi: 10.1016/j.socscimed.2007.01.019.
    1. Kayongo M, Rubardt M, Butera J, Abdullah M, Mboninyibuka D, Madili M. Making EmOC a reality–CARE’s experiences in areas of high maternal mortality in Africa. Int J Gynaecol Obstet. 2006;92:308–19. doi: 10.1016/j.ijgo.2005.12.003.
    1. Pearson L, Shoo R. Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda. Int J Gynaecol Obstet. 2005;88:208–15. doi: 10.1016/j.ijgo.2004.09.027.
    1. WHO, World Bank, UNICEF, UNFPA. Trends in Maternal Mortality: 1990 to 2015. 2015. Available: . Accessed: 26 April 2017.
    1. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387:462–74. doi: 10.1016/S0140-6736(15)00838-7.
    1. Kidney E, Winter HR, Khan KS, Gulmezoglu AM, Meads CA, Deeks JJ, et al. Systematic review of effect of community-level interventions to reduce maternal mortality. BMC Pregnancy Childbirth. 2009;9:2. doi: 10.1186/1471-2393-9-2.
    1. Lassi ZS, Kumar R, Bhutta ZA. Community-based care to improve maternal, newborn, and child health. 2016. In: Disease Control Priorities: Reproductive, Maternal, Newborn, and Child Health, Third Edition. Washington, DC: World Bank; [263-94]. Available: . Accessed: 26 April 2017.
    1. Perry H, Rassekh B, Gupta S, Wilhelm J, Freeman P. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 1. rationale, methods and database description. J Glob Health. 2017;7:010901.
    1. Sacks E, Freeman P, Sakyi K, Jennings M, Rassekh B, Gupta S, et al. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 3. neonatal health findings. J Glob Health. 2017;7:010903.
    1. Freeman P, Schleiff M, Sacks E, Rassekh B, Gupta S, Perry H. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 4. child health findings. J Glob Health. 2017;7:010904.
    1. Schleiff M, Kumapley R, Freeman P, Gupta S, Rassekh B, Perry H. Vomprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 5. equity effects. J Glob Health. 2017;7:010905.
    1. Perry H, Rassekh B, Gupta S, Freeman P. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects. J Glob Health. 2017;7:010906.
    1. Perry H, Rassekh B, Gupta S, Freeman P. A comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 7. programs with evidence of long-term impact on mortality in children younger than five years of age. J Glob Health. 2017;7:010907.
    1. Dutt D, Srinivasa DK. Impact of maternal and child health strategy on child survival in a rural community of Pondicherry. Indian Pediatr. 1997;34:785–92.
    1. Baqui A, Williams EK, Rosecrans AM, Agrawal PK, Ahmed S, Darmstadt GL, et al. Impact of an integrated nutrition and health programme on neonatal mortality in rural northern India. Bull World Health Organ. 2008;86:796–804. doi: 10.2471/BLT.07.042226.
    1. Rahman M, Jhohura FT, Mistry SK, Chowdhury TR, Ishaque T, Shah R, et al. Assessing Community Based Improved Maternal Neonatal Child Survival (IMNCS) Program in Rural Bangladesh. PLoS One. 2015;10:e0136898. doi: 10.1371/journal.pone.0136898.
    1. Lassi ZS, Haider BA, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev. 2010;11:CD007754.
    1. WHO. Antenatal care in developing countries. Promises, achievements and missed opportunities: an analysis of trends, levels and differentials. 2003. Available: . Accessed: 26 April 2017.
    1. Homer CS, Friberg IK, Dias MA, ten Hoope-Bender P, Sandall J, Speciale AM, et al. The projected effect of scaling up midwifery. Lancet. 2014;384:1146–57. doi: 10.1016/S0140-6736(14)60790-X.
    1. Byrne A, Morgan A. How the integration of traditional birth attendants with formal health systems can increase skilled birth attendance. Int J Gynaecol Obstet. 2011;115:127–34. doi: 10.1016/j.ijgo.2011.06.019.
    1. Lane K, Garrod J. The return of the Traditional Birth Attendant. J Glob Health. 2016;6:020302. doi: 10.7189/jogh.06.020302.
    1. Costello A, Azad K, Barnett S. An alternative strategy to reduce maternal mortality. Lancet. 2006;368:1477–9. doi: 10.1016/S0140-6736(06)69388-4.
    1. Miller S, Cordero M, Coleman AL, Figueroa J, Brito-Anderson S, Dabagh R, et al. Quality of care in institutionalized deliveries: the paradox of the Dominican Republic. Int J Gynaecol Obstet. 2003;82:89–103, discussion 87-8. doi: 10.1016/S0020-7292(03)00148-6.
    1. WHO. The World Health Report 2005 - make every mother and child count. 2005. Available: . Accessed: 26 April 2017.
    1. Souza JP, Gulmezoglu AM, Vogel J, Carroli G, Lumbiganon P, Qureshi Z, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study. Lancet. 2013;381:1747–55. doi: 10.1016/S0140-6736(13)60686-8.
    1. Stollak I, Valdez M, Rivas K, Perry H. Casas Maternas in the Rural Highlands of Guatemala: A Mixed-Methods Case Study of the Introduction and Utilization of Birthing Facilities by an Indigenous Population. Glob Health Sci Pract. 2016;4:114–31. doi: 10.9745/GHSP-D-15-00266.
    1. Manandhar DS, Osrin D, Shrestha BP, Mesko N, Morrison J, Tumbahangphe KM, et al. Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: cluster-randomised controlled trial. Lancet. 2004;364:970–9. doi: 10.1016/S0140-6736(04)17021-9.
    1. Azad K, Barnett S, Banerjee B, Shaha S, Khan K, Rego AR, et al. Effect of scaling up women’s groups on birth outcomes in three rural districts in Bangladesh: a cluster-randomised controlled trial. Lancet. 2010;375:1193–202. doi: 10.1016/S0140-6736(10)60142-0.
    1. Singh S, Darroch J, Ashford L. Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health 2014. 2014. Available: . Accessed. 26 April 2017.
    1. Prata N, Vahidnia F, Potts M, Dries-Daffner I. Revisiting community-based distribution programs: are they still needed? Contraception. 2005;72:402–7. doi: 10.1016/j.contraception.2005.06.059.
    1. Stanback J, Spieler J, Shah I, Finger WR. Community-based health workers can safely and effectively administer injectable contraceptives: conclusions from a technical consultation. Contraception. 2010;81:181–4. doi: 10.1016/j.contraception.2009.10.006.
    1. Kearns AD, Caglia JM, Ten Hoope-Bender P, Langer A. Antenatal and postnatal care: a review of innovative models for improving availability, accessibility, acceptability and quality of services in low-resource settings. BJOG. 2016;123:540–8. doi: 10.1111/1471-0528.13818.
    1. Lunze K, Higgins-Steele A, Simen-Kapeu A, Vesel L, Kim J, Dickson K. Innovative approaches for improving maternal and newborn health–a landscape analysis. BMC Pregnancy Childbirth. 2015;15:337. doi: 10.1186/s12884-015-0784-9.
    1. Labrique AB, Vasudevan L, Kochi E, Fabricant R, Mehl G. mHealth innovations as health system strengthening tools: 12 common applications and a visual framework. Glob Health Sci Pract. 2013;1:160–71. doi: 10.9745/GHSP-D-13-00031.

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