Table 2 Overview of included studies
Country | Strategy | Description of strategy | Type of MNH care | Study design | Study year | Magnitude/Measure of effect | Author (Year) | Reference |
|---|---|---|---|---|---|---|---|---|
Bangladesh | Women’s groups & health system strengthening (HSS) | Recruit & train facilitators to convene monthly women’s group meetings. Women’s groups encouraged to adopt strategies to improve MNH. In all clusters basic medical equipment supplied, TBAs trained in essential newborn care, physicians trained, and links established between communities and health services. | MNH, especially newborn | Cluster RCT | 2009- 2011 | NMR per 1000 LB Adj RR = 0.62 (95% CI: 0.43-0.89) | Fottrell (2013) | [18] |
Bangladesh | Vouchers for free MNH care, cash and in-kind transfers | Family welfare assistants (FWAs) distribute vouchers to (eligible) pregnant women entitling them to free ANC, delivery, emergency referral & post-partum care. Cash stipends for transport & other costs. Cash incentive to deliver in facility or at home with skilled provider. In-kind items (including soap and newborn clothes) supplied. Providers reimbursed for services provided. | All MNH | Intervention & control areas | 2008- 2009 | % of deliveries with qualified provider: 58-70% (S), 27% (C) | Hatt (2010) | [19] |
Bangladesh | Improve health and family welfare clinics | Staff & equip primary health facilities to provide delivery & newborn care (incl. additional staff, improved infrastructure, equipment and supplies). | Facility-birth | Cost projection | 2011 | Estimated number of clients per year | Howlander (2011) | [20] |
Bangladesh | Promotion of NGO health clinics: | Smiling Sun communication campaign to promote NGO clinics (incl. 26 episode TV drama, TV adverts, radio spots, posters, billboards, adverts in daily newspapers, & local publicity efforts). | Facility-based ANC | Secondary data analysis | 2001- 2004 | Estimated number of new ANC users | Hutchinson (2006) | [21] |
1. National media campaign | ||||||||
2. National media campaign & local activities | ||||||||
Bangladesh | MNH services delivered at home, with community mobilization and health system strengthening (HSS) | CHWs recruited and trained to conduct home visits during pregnancy and post-natal period (incl. treatment of newborns with antibiotics). Communities were mobilized. HSS in all clusters: facility-level providers trained in MNH care, drugs & supplies distributed, & system for tracking neonatal care established. | All MNH | Cluster RCT | 2003- 2005 | NMR per 1000 LB: 31.2 (S), 43.1 (C) | LeFevre (2013) | [22] |
Bangladesh | Outreach clinics for FP and ANC by facility staff†| Increase number of outreach clinics and extend opening hours. Compared to services (ANC care) provided at primary care facilities. | Pregnancy | Intervention & control areas | 1996- 1997 | Number of ANC services provided | Levin (1997 & 1999) | |
Bangladesh | Alternative delivery strategies FP & MCH | 1. FP & MCH services by government fieldworkers at community service points (e.g. clubs, schools); | FP & MCH | Intervention & control areas | 1996- 1997 | Number of ANC services provided | Routh (2000) | [25] |
2. FP & MCH services provided at primary care facility Compared to FP & MCH services provided at home by government fieldworkers. | ||||||||
Bangladesh | Train TBAs | TBAs trained and encouraged to refer difficult births. | Intra-partum | Estimated from secondary data | Not given | Neonatal lives saved per 1000 LB: 7 (estimate) | World Bank (2005) | [26] |
Benin & Guinea | Bamako Initiative | Various strategies to improve primary care, incl. integrated minimum package of preventive and curative MNCH care. | ANC (incl. prophylaxis for malaria & anaemia) | Secondary data analysis | 1989- 1993 | % of pregnant women having at least 3 ANC visits: 43% Benin, 55% Guinea | Soucat (1997) | [27] |
Burkina Faso | Train new cadres in EmOC | Develop and implement training: | EmOC | Pre-Post | 2004- 2007 | Newborn case fatality rate per 1000 c-sections: 125 (S1), 198 (S2), 99 (C) | Hounton (2009) | [28] |
S1. Six-months in essential surgery for medical doctors, | ||||||||
S2. Two-years in surgery (incl. C-section) for clinical officers. | ||||||||
C. Compared to training obstetricians | ||||||||
Burkina Faso | Initiative to promote facility-birth | Recruit & train of community link workers. Community mobilization by traditional leaders to promote assisted delivery. Also PHC staff trained, equipment supplied & infrastructure improved. | Facility-birth | Intervention & control areas | 2002- 2005 | 20.8% point increase in births delivered in a facility | Newlands (2008) & Hounton (2012) | |
Cambodia | Introduce HIV testing: | Facilities supplied HIV test kits. Five-day HIV training for midwives. Facility paid per person tested, and per person counselled and referred. Monthly staff meetings and regular supervision. | HIV testing & mgmt | Pre-Post | 2008- 2009 | % tested for HIV: 97.6% at ANC, 95% at labour | Heller (2011) | [31] |
1. at ANC | ||||||||
2. at labour | ||||||||
Cambodia | Community health education by midwives | Midwives trained to lead focus group discussions to engage community on maternal health. | Birth preparedness | Pre-Post | 2005- 2006 | 22% increase in ANC, 32% increase births with midwife, 19% decrease in women using TBAs, 281% increase in referrals | Skinner (2009) | [32] |
Democratic Republic of Congo | Distribute malaria ITNs at ANC | Nurses trained to distribute ITNs to pregnant women attending ANC. | Malaria prevention | Economic model (incl. primary data) | 2005- 2006 | Number of ITNs delivered, and estimated number of infant deaths averted | Becker-Dreps (2009) | [33] |
The Gambia | Outreach maternal health care | Outreach ANC clinics ran by midwives & community nurses. Activities to identify pregnant women, support for referral). Also train TBAs (incl. 6 month refresher). New fixed price for MNH care. | Pregnancy & Intra-partum | Intervention & control areas | 1989- 1991 | NMR per 1000 LB: 16 (S), 32.2 (C) MMR per 1000 LB: 3.1 (S), 7 (C) | Fox-Rushby (1995 & 1996) | |
Honduras | Hospital-based promotion of breastfeeding | Hospital staff trained to educate & encourage mothers to breastfeed. Included changes to establish early breastfeeding contact, rooming-in of babies with mothers, withdrawal of routine bottle feeding, & post-partum counselling. | Promote breastfeeding | Intervention & control areas | 1992- 1993 | % exclusive breastfeeding: 42.7% (S), 22.2% (C) | Horton (1996) | [36] |
Neonatal deaths averted per 1000: 1.02 (from acute respiratory infection), 3.48 (from diarrhoea) | ||||||||
India | Women’s groups & health system strengthening (HSS) | Recruited & trained facilitators to convene monthly women’s group meetings. Women’s groups encouraged to adopt strategies to improve MNH. HSS (incl. training in newborn care, equipment & supplies) in all areas. | All MNH | Cluster RCT | 2005- 2008 | NMR per 1000 LB: 42.9 (S), 59.1 (C); Adj OR = 0.71 (95% CI: 0.61-0.83) | Tripathy (2010) | [37] |
India | HIV testing at ANC: | Activities include: health education using local media campaign and HIV testing, counselling, drug treatment at ANC. | HIV testing & management | Economic model | 2005 | Estimated number of cases of perinatal HIV prevented | Kumar (2006) | [38] |
1. nationwide | ||||||||
2. in high prevalence states | ||||||||
India | Home-based neonatal care by Village Health Workers (VHWs) | Recruit and train female VHWs to identify & counsel pregnant women, & to undertake home-based neonatal care. Also VHWs may support TBAs at delivery. VHWs were supervised every 2 weeks. | All MNH, esp. thermal care, birth asphyxia, breastfeeding, neonatal sepsis | Pre-Post + Control | 1993- 2003 | 70% reduction in NMR per 1000 LB: 62 (Pre), 25 (Post) | Bang (2005a) | [39] |
India | Home-based management of birth asphyxia by Village Health Workers (VHWs) | Trained female VHWs to diagnose and manage birth asphyxia (when support TBAs at delivery) Compared to current practice (with TBAs trained to manage birth asphyxia. | Birth asphyxia | Pre-Post | 1996- 2003 | 65% reduction in NMR per 1000 LB: 10.5 (Pre), 3.6 (Post) | Bang (2005b) | [40] |
India | Home-based neonatal care by Village Health Workers (VHWs) | Recruit and train female VHWs to identify & counsel pregnant women, & to undertake home-based neonatal care. Also VHWs may support TBAs at delivery. VHWs were supervised every 2 weeks. | All MNH, esp. thermal care, birth asphyxia, breastfeeding, neonatal sepsis | Pre-Post + Control | 1993- 1998 | 62% reduction in NMR per 1000 LB in year 3: 25.5 (S), 59.6 (C) | Bang (1999) | [41] |
Indonesia | Tetanus toxoid (TT) immunization campaign | TT immunization campaign by new nursing graduates, supported by community mobilization using village heads and women’s groups. Compared to TT immunization at routine ANC. | Tetanus toxoid immunization | Intervention & control areas | 1985 | Number of women who received full TT dose, and estimated number of neonatal (tetanus) deaths averted | Berman (1991) | [42] |
Kenya | Distribute malaria ITN at ANC | Facilities instructed to procure ITNs and distribute to pregnant women during ANC. | Malaria prevention | Prospective | 2001 | Reports number ITNs distributed. 77% were to pregnant women | Guyatt (2002) | [43] |
Kenya | Syphilis testing at ANC. | On-site syphilis testing using rapid syphilis test, on-site same day treatment of RPR-positive, promotion of notification and presumptive treatment of women’s partners. | Syphilis testing & treatment | Pre-Post | 1998- 2000 | % clients at ANC screened: 81% (S1), 51% (S2) | Population Council (2001) | [44] |
1. on-site | ||||||||
2. standard clinics (off-site) | ||||||||
Kenya | Decentralized programme of syphilis control | Programme included: laboratory support; supplies and drugs; training ANC nurses in rapid syphilis testing and treatment of seroactive women; counselling; partner notification; supervision & monitoring. | Syphilis diagnosis and treatment | Pre-Post | 1997- 1998 | Number of women screened, number test-positive, & number treated | Fonck (2001) | [45] |
Kenya | Decentralized programme of syphilis control | Programme included: laboratory support; supplies and drugs; training ANC nurses in rapid syphilis testing and treatment of seroactive women; counselling; partner notification; supervision & monitoring. | Syphilis testing & mgmt | Pre-Post | 1992- 1993 | Number of syphilis cases treated, and estimated number of congenital syphilis averted | Jenniskens (1995) | [46] |
Malawi | 1. Women’s groups | 1. Recruited & trained facilitators to convene women's groups. Women's groups encouraged to identify and adopt local strategies to improve MNH. | All MNH | Factorial Cluster RCT | 2008- 2010 | NMR per 1000 LB: 27.0 (S3), 34.0 (C); Adj OR = 0.78 (95% CI: 0.60-1.01) | Colbourn (2013a & 2013b) | |
2. Quality improvement at health facilities, | ||||||||
3. Both 1 & 2 | 2. Facility staff trained to initiate and run quality improvement initiative. Facility staff to identify & adopt local strategies to improve facility-based services (e.g. staff training needs). | |||||||
Malawi | 1. Women’s groups | 1. Recruited & trained facilitators to convene women's groups. Women’s groups encouraged to identify and adopt local strategies to improve MNH. 2. Volunteer peer counsellors made home visits during pregnancy and post-birth to support breastfeeding and infant care. | All MNH | Factorial Cluster RCT | 2005- 2009 | Factorial analysis: NMR per 1000 LB (S1 vs C): OR = 0.85 (95% CI: 0.59-1.22) MMR per 100,000 LB (S1 vs C): OR = 0.48 (95% CI: 0.26-0.91) IMR per 1000 LB (S2 vs C): OR = 0.89 (95% CI: 0.72-1.10) | Lewycka (2013) | [49] |
2. Peer counselling | ||||||||
3. Both 1 & 2 | ||||||||
Mozambique | Train Assistant Medical Officers in Emergency Obstetric Care (EmOC) | Two-year classroom-based instruction followed by 1-year internship. (In comparison, physicians receive 6-years of medical training and 5-year residency in surgery and obstetrics). | EmOC | Economic model (primary data) | 2004 | Number of obstetric surgeries performed | Kruk (2007) | [50] |
Nepal | Women’s groups & health system strengthening (HSS) | Recruited & trained facilitators to convene monthly women’s group meetings. Women’s groups encouraged to adopt strategies to improve MNH (e.g. community-fund, stretcher schemes, clean delivery kits, home visits). HSS (incl. training in newborn care, equipment & supplies) in all areas. | All MNH | Cluster RCT | 1999- 2003 | NMR per 1000 LB 26.2 (S), 36.9 (C). | Borghi (2005) | [51] |
Adj OR = 0.70 (95% CI: 0.53-0.94) | ||||||||
Niger | Quality improvement collaborative | Used facility data to monitor indicators of common technical interventions. Staff worked collaboratively to identify strategies to overcome service delivery barriers and improve facility care. | Intra-partum/Post-partum care (incl. AMTSL & PPH) | Pre-Post | 2006- 2008 | MMR per 10,000 vaginal births (projected:) 7.11 (Pre), 0.98 (Post) | Broughton (2013) | [52] |
Niger | Programme to treat obstetric urogenital fistula | Programme include hospital stay, hygiene education, medical and surgical treatment and social rehabilitation interventions. All provided free of charge. | Obstetric urogential fistula | Pre-Post | 2006 | Number of women benefitting from the programme during study period | Ndiaye (2009) | [53] |
Nigeria | Establish and train community contact persons | Select and trained contact persons to provide community health education, visit pregnant women, & facilitate referral (if needed). | Pregnancy; & support referral | Pre-Post | 1993- 1995 | Number of women assisted by contact persons during study period | Nwakoby (1997) | [54] |
Nigeria | Establish emergency transport scheme | Mobilize transport union, drivers given basic training & awareness on health topics. Also seed money to establish revolving petrol fund. | Emergencies (pregnancy & intra-partum) | Pre-Post | 1994- 1995 | Number of obstetric emergencies transported during study period. | Shehu (1997) | [55] |
Papua New Guinea | Improve standard of special neonatal care | Special care nurses trained on management of neonatal illnesses, including new treatment protocol for low-birth weight babies. Special care units provided equipment (e.g. pulse oximetry). Also clinical supervision and a weekly mortality audit. | Special neonatal care (incl. mgmt birth asphyxia, neonatal sepsis, pneumonia) | Pre-Post | 1995- 2000 | In-hospital neonatal mortality: RR = 0.56 (95% CI: 0.45-0.69) | Duke (2000) | [56] |
Senegal | Remove user fees for intra-partum care | Removed user fees for intra-partum care (including caesarean section) in poor regions. | Facility-birth (incl. c-section) | Pre-Post | 2004- 2006 | % births supervised by normal delivery: 40% (Pre), 44% (Post) | Witter (2010) | [57] |
% of births by C-section 4.2% (Pre), 5.6% (Post) | ||||||||
Uganda | Compare four strategies for abortion care | Alternative strategies are defined along two dimensions: availability and type of practice: | Abortion care | Economic Model | 1996 | Not applicable estimates cost per abortion case | Johnston (2007) | [58] |
1 Restricted-conventional, | ||||||||
2. Restricted-recommended, | ||||||||
3. Liberal-conventional, 4. Liberal-recommended. Also examined strategies at different levels of care. | ||||||||
Uganda | Home-based distribution of intermittent preventive treatment in pregnancy (IPTp) | Community resource persons trained to identify pregnant women, make home visits and distribute IPTp, folic acid and iron supplements. Compared to IPTp distributed at PHC during ANC. | Malaria prevention (IPTp) | Prospective | 2003- 2005 | % of women with anaemia: 49% (S), 41% (C) % of LBW babies: 8% (S), 6% (C) | Mbonye (2008a & (2008b) | |
Uganda | Establish emergency transport | Established local ambulance service available 24 hours. | Emergencies (pregnancy & intra-partum) | Pre-Post | 2009- 2010 | Number of obstetric referrals during study period | Somigliana (2011) | [61] |
Ukraine | Initiative on evidence-based practice in maternal and infant hospital care | Eight-year project advocating reduction in (elective) c-sections and evidence-based medical practices (incl. amniotomies and episiotomies, early breastfeeding, skin-to-skin contact, rooming in). Maternity staff trained & sought to develop centres of excellence. | Intra-partum & newborn care | Pre-Post | 2002- 2005 | 4.71% reduction in number of (elective) C-sections | Nizalova (2010) | [62] |
Zambia | Syphilis testing at ANC | Facilities supplied syphilis tests. Five-day training on pregnancy care (incl. syphilis). Also used community health education via local leaders to improve ANC attendance. | Syphilis testing & mgmt | Pre-Post + Control | 1986- 1987 | % of adverse pregnancy outcomes among seroreactive women: 28.3% (S), 72.4% (C) | Hira (1990) | [63] |
Zambia | Train midwives in newborn care | Clinic midwives trained using 5-day WHO course on neonatal care and management of neonatal illnesses. | Newborn care (incl thermal care & breastfeeding) | Pre-Post | 2004- 2006 | NMR per 1000 (by 7-day): 11.5 (Pre), 6.8 (Post) RR = 0.59 (95% CI: 0.48–0.77) | Manasyan (2011) | [64] |
Zambia | Train TBAs & supply clean delivery kits | TBAs trained over 4-day training (with refresher training every 3–4 months), provided equipment and clean delivery kits. | Intra-partum & newborn care | Cluster RCT | 2006- 2008 | Estimated number of neonatal deaths averted | Sabin (2012) | [65] |