TY - JOUR
T1 - Strategies for improving health care seeking for maternal and newborn illnesses in low- and middle-income countries
T2 - A systematic review and meta-analysis
AU - Lassi, Zohra S.
AU - Middleton, Philippa F.
AU - Bhutta, Zulfiqar A.
AU - Crowther, Caroline
N1 - Publisher Copyright:
© 2016 Zohra S. Lassi et al.
PY - 2016
Y1 - 2016
N2 - Background: Lack of appropriate health care seeking for ill mothers and neonates contributes to high mortality rates. A major challenge is the appropriate mix of strategies for creating demand as well as provision of services. Design: Systematic review and meta-analysis of experimental studies (last search: Jan 2015) to assess the impact of different strategies to improve maternal and neonatal health care seeking in low- and middleincome countries (LMIC). Results: Fifty-eight experimental [randomized controlled trials (RCTs), non-RCTs, and before-after studies] with 310,652 participants met the inclusion criteria. Meta-analyses from 29 RCTs with a range of different interventions (e.g. mobilization, home visitation) indicated significant improvement in health care seeking for neonatal illnesses when compared with standard/no care [risk ratio (RR) 1.40; 95 confidence interval (CI): 1.17-1.68, 9 studies, n=30,572], whereas, no impact was seen on health care seeking for maternal illnesses (RR 1.06; 95% CI: 0.92-1.22, 5 studies, n=15,828). These interventions had a significant impact on reducing stillbirths (RR 0.82; 95% CI: 0.73-0.93, 11 studies, n=176,683), perinatal deaths (RR 0.84; 95% CI: 0.77-0.90, 15 studies, n=279,618), and neonatal mortality (RR 0.80; 95% CI: 0.72-0.89, 20 studies, n=248,848). On GRADEapproach, evidence was high quality except for the outcome ofmaternal health care seeking,which was moderate. Conclusions: Community-based interventions integrating strategies such as home visiting and counseling can help to reduce fetal and neonatal mortality in LMIC.
AB - Background: Lack of appropriate health care seeking for ill mothers and neonates contributes to high mortality rates. A major challenge is the appropriate mix of strategies for creating demand as well as provision of services. Design: Systematic review and meta-analysis of experimental studies (last search: Jan 2015) to assess the impact of different strategies to improve maternal and neonatal health care seeking in low- and middleincome countries (LMIC). Results: Fifty-eight experimental [randomized controlled trials (RCTs), non-RCTs, and before-after studies] with 310,652 participants met the inclusion criteria. Meta-analyses from 29 RCTs with a range of different interventions (e.g. mobilization, home visitation) indicated significant improvement in health care seeking for neonatal illnesses when compared with standard/no care [risk ratio (RR) 1.40; 95 confidence interval (CI): 1.17-1.68, 9 studies, n=30,572], whereas, no impact was seen on health care seeking for maternal illnesses (RR 1.06; 95% CI: 0.92-1.22, 5 studies, n=15,828). These interventions had a significant impact on reducing stillbirths (RR 0.82; 95% CI: 0.73-0.93, 11 studies, n=176,683), perinatal deaths (RR 0.84; 95% CI: 0.77-0.90, 15 studies, n=279,618), and neonatal mortality (RR 0.80; 95% CI: 0.72-0.89, 20 studies, n=248,848). On GRADEapproach, evidence was high quality except for the outcome ofmaternal health care seeking,which was moderate. Conclusions: Community-based interventions integrating strategies such as home visiting and counseling can help to reduce fetal and neonatal mortality in LMIC.
KW - Developing countries
KW - Health care seeking
KW - Low- and middle-income countries
KW - Maternal health
KW - Neonatal health
KW - Neonatal mortality
KW - Perinatal mortality
UR - http://www.scopus.com/inward/record.url?scp=84969504878&partnerID=8YFLogxK
U2 - 10.3402/gha.v9.31408
DO - 10.3402/gha.v9.31408
M3 - Review article
C2 - 27171766
AN - SCOPUS:84969504878
SN - 1654-9716
VL - 9
JO - Global Health Action
JF - Global Health Action
IS - 1
M1 - 31408
ER -