TY - JOUR
T1 - The Effectiveness of Regionalization of Perinatal Care and Specific Facility-Based Interventions
T2 - A Systematic Review
AU - Ali, Ayesha Arshad
AU - Naseem, Hamna Amir
AU - Allahuddin, Zoha
AU - Yasin, Rahima
AU - Azhar, Maha
AU - Hanif, Sawera
AU - Das, Jai K.
AU - Bhutta, Zulfiqar A.
N1 - Publisher Copyright:
© 2024 The Author(s). Published by S. Karger AG, Basel.
PY - 2024
Y1 - 2024
N2 - Introduction: Appropriate perinatal care provision and utilization is crucial to improve maternal and newborn survival and potentially meet Sustainable Development Goal 3. Ensuring availability of healthcare infrastructure as well as skilled personnel can potentially help improve maternal and neonatal outcomes globally as well as in resource-limited settings. Methods: A systematic review on effectiveness of perinatal care regionalization was updated, and a new review on facility-based interventions to improve postnatal care coverage and outcomes was conducted. The interventions were identified through literature reviews and included transport, mHealth, telemedicine, maternal education, capacity building, and incentive packages. Search was conducted in relevant databases and meta-analysis conducted on Review Manager 5.4. We conducted subgroup analysis for evidence from low- and middle-income countries (LMICs). Results: Implementation of regionalization programs significantly decreased maternal mortality in LMICs (OR: 0.43; 95% CI: 0.34-0.55, 2 studies), stillbirth overall (OR: 0.70; 95% CI: 0.54-0.89, 5 studies), perinatal mortality overall (OR: 0.54; 95% CI: 0.5-0.58, 2 studies), and LMICs (OR: 0.54; 95% CI: 0.50-0.58, 1 study). Transport-related interventions significantly decreased maternal mortality overall (OR: 0.55; 95% CI: 0.40-0.74, 1 study), neonatal mortality (RR: 0.76; 95% CI: 0.66-0.88, 1 study), perinatal mortality (RR: 0.86; 95% CI: 0.77-0.95, 1 study), and improved postnatal care coverage (OR: 6.89; 95% CI: 5.15-9.21, 1 study) in LMICs. Adding maternity homes/units significantly decreased stillbirth (OR: 0.75; 95% CI: 0.61-0.93, 1 study) in LMICs. Incentives for postnatal care significantly improved infant mortality (RR: 0.79; 95% CI: 0.65-0.96, 1 study), stillbirth (OR: 0.60; 95% CI: 0.44-0.83, 1 study), and postnatal care coverage (RR: 1.13; 95% CI: 1.03-1.25, 1 study) in LMICs. Telemedicine improved postnatal care coverage significantly in LMICs (RR: 2.54; 95% CI: 1.22-5.28, 3 studies) and decreased maternal mortality (OR: 0.46; 95% CI: 0.21-0.98, 1 study) and infant mortality (OR: 0.65; 95% CI: 0.45-0.95) in LMICs. Maternal education significantly decreased neonatal mortality (RR: 0.75; 95% CI: 0.66-0.84, 2 studies), perinatal mortality (RR: 0.86; 95% CI: 0.77-0.95, 1 study), infant mortality (RR: 0.79; 95% CI: 0.65-0.96, 1 study), and stillbirth (RR: 0.61; 95% CI: 0.45-0.82, 1 study). Capacity-building interventions significantly decreased maternal mortality in LMICs (OR: 0.37; 95% CI: 0.29-0.46, 5 studies), neonatal mortality overall (OR: 0.72; 95% CI: 0.53-0.98, 4 studies) and in LMICs (OR: 0.63; 95% CI: 0.54-0.74, 3 studies, and RR: 0.61; 95% CI: 0.48-0.79, 3 studies), perinatal mortality (OR: 0.53; 95% CI: 0.45-0.62, 2 studies, and RR: 0.86; 95% CI: 0.77-0.95, 1 study), infant mortality (OR: 0.50; 95% CI: 0.43-0.59, 1 study, and RR: 0.79; 95% CI: 0.65-0.96, 1 study), under-5 mortality (RR: 0.79; 95% CI: 0.66-0.94, 1 study), and stillbirth in LMICs (OR: 0.71; 95% CI: 0.62-0.82, 4 studies), and preterm birth overall (OR: 0.39; 95% CI: 0.19-0.81, 1 study). Conclusion: Perinatal regionalization and facility-based interventions have a positive impact on maternal and neonatal outcomes and calls for implementation in high burden settings but a better understanding of optimal interventions is needed through comprehensive trials in diverse settings.
AB - Introduction: Appropriate perinatal care provision and utilization is crucial to improve maternal and newborn survival and potentially meet Sustainable Development Goal 3. Ensuring availability of healthcare infrastructure as well as skilled personnel can potentially help improve maternal and neonatal outcomes globally as well as in resource-limited settings. Methods: A systematic review on effectiveness of perinatal care regionalization was updated, and a new review on facility-based interventions to improve postnatal care coverage and outcomes was conducted. The interventions were identified through literature reviews and included transport, mHealth, telemedicine, maternal education, capacity building, and incentive packages. Search was conducted in relevant databases and meta-analysis conducted on Review Manager 5.4. We conducted subgroup analysis for evidence from low- and middle-income countries (LMICs). Results: Implementation of regionalization programs significantly decreased maternal mortality in LMICs (OR: 0.43; 95% CI: 0.34-0.55, 2 studies), stillbirth overall (OR: 0.70; 95% CI: 0.54-0.89, 5 studies), perinatal mortality overall (OR: 0.54; 95% CI: 0.5-0.58, 2 studies), and LMICs (OR: 0.54; 95% CI: 0.50-0.58, 1 study). Transport-related interventions significantly decreased maternal mortality overall (OR: 0.55; 95% CI: 0.40-0.74, 1 study), neonatal mortality (RR: 0.76; 95% CI: 0.66-0.88, 1 study), perinatal mortality (RR: 0.86; 95% CI: 0.77-0.95, 1 study), and improved postnatal care coverage (OR: 6.89; 95% CI: 5.15-9.21, 1 study) in LMICs. Adding maternity homes/units significantly decreased stillbirth (OR: 0.75; 95% CI: 0.61-0.93, 1 study) in LMICs. Incentives for postnatal care significantly improved infant mortality (RR: 0.79; 95% CI: 0.65-0.96, 1 study), stillbirth (OR: 0.60; 95% CI: 0.44-0.83, 1 study), and postnatal care coverage (RR: 1.13; 95% CI: 1.03-1.25, 1 study) in LMICs. Telemedicine improved postnatal care coverage significantly in LMICs (RR: 2.54; 95% CI: 1.22-5.28, 3 studies) and decreased maternal mortality (OR: 0.46; 95% CI: 0.21-0.98, 1 study) and infant mortality (OR: 0.65; 95% CI: 0.45-0.95) in LMICs. Maternal education significantly decreased neonatal mortality (RR: 0.75; 95% CI: 0.66-0.84, 2 studies), perinatal mortality (RR: 0.86; 95% CI: 0.77-0.95, 1 study), infant mortality (RR: 0.79; 95% CI: 0.65-0.96, 1 study), and stillbirth (RR: 0.61; 95% CI: 0.45-0.82, 1 study). Capacity-building interventions significantly decreased maternal mortality in LMICs (OR: 0.37; 95% CI: 0.29-0.46, 5 studies), neonatal mortality overall (OR: 0.72; 95% CI: 0.53-0.98, 4 studies) and in LMICs (OR: 0.63; 95% CI: 0.54-0.74, 3 studies, and RR: 0.61; 95% CI: 0.48-0.79, 3 studies), perinatal mortality (OR: 0.53; 95% CI: 0.45-0.62, 2 studies, and RR: 0.86; 95% CI: 0.77-0.95, 1 study), infant mortality (OR: 0.50; 95% CI: 0.43-0.59, 1 study, and RR: 0.79; 95% CI: 0.65-0.96, 1 study), under-5 mortality (RR: 0.79; 95% CI: 0.66-0.94, 1 study), and stillbirth in LMICs (OR: 0.71; 95% CI: 0.62-0.82, 4 studies), and preterm birth overall (OR: 0.39; 95% CI: 0.19-0.81, 1 study). Conclusion: Perinatal regionalization and facility-based interventions have a positive impact on maternal and neonatal outcomes and calls for implementation in high burden settings but a better understanding of optimal interventions is needed through comprehensive trials in diverse settings.
KW - Maternal health
KW - Neonates
KW - Perinatal regionalization
KW - Postnatal care
UR - http://www.scopus.com/inward/record.url?scp=85209221774&partnerID=8YFLogxK
U2 - 10.1159/000541384
DO - 10.1159/000541384
M3 - Article
C2 - 39504943
AN - SCOPUS:85209221774
SN - 1661-7800
JO - Neonatology
JF - Neonatology
M1 - 541384
ER -