From: Systematic review of effect of community-level interventions to reduce maternal mortality
Study | Design | Intervention | n | Quality assessment | MMR Intervention | MMR Control | OR (95%CI) |
---|---|---|---|---|---|---|---|
Manandhar 2004[17] rural Nepal | Cluster RCT 24 clusters | Facilitator-led women's groups to improve perinatal care practices plus health-service strengthening vs. usual care plus health-service strengthening | 28,931 women of childbearing age 6,714 pregnancies 6,165 live births | 1:medium; 2: low; 3: medium ; 4: high | 69 | 341 | 0.28 (0.09 to 0.82) |
Jokhio 2005[15] rural Pakistan | Cluster RCT 7 clusters | TBA training and health service integration, issue of sterile delivery kits vs. usual care | 19,557 pregnant women 19,524 deliveries | 1:high; 2:high; 3 high; 4: high | 268 | 360 | 0.74 (0.45 to 1.23) |
Munjanja 1996[16] Harare, Zimbabwe | Cluster RCT 7 clusters | Intervention: fewer, but goal-oriented antenatal visits vs. standard "westernised" antenatal care | 15,994 low risk pregnancies 15,532 deliveries | 1:medium; 2: medium; 3:medium; 4: low | 64 | 82 | 0.78 (0.23 to 2.61) |
Villar 2001 [20] Argentina, Cuba, Saudi Arabia, Thailand | Cluster RCT 53 clusters | Intervention: fewer, but goal-oriented antenatal visits vs. standard "westernised" antenatal care | 24,526 low risk pregnant women 22,793 single births | 1:high; 2:high 3: medium 4:high | 60 | 54 | 1.11 (0.37 to 3.29) |
Majoko 2007[19] rural Zimbabwe | Cluster RCT 23 clusters | Intervention: fewer, but goal-oriented antenatal visits vs. standard "westernised" antenatal care | 13179 pregnant women | 1:medium; 2:high; 3: low; 4: high | 60 | 31 | 1.90 (0.38 to 9.43) |
Ackermann-Liebrich 1996[28] Switzerland | Prospective cohort study with nested matched pairs | Women opting for home vs. hospital birth in "westernised" setting | 874 pregnant women 857 deliveries | 1:low; 2: low; 3 :not applicable; 4:low | 0 | 0 | |
de Bernis 2000, Senegal | Prospective survey of two cohorts | Women in Kaolack delivered mainly by TBAs in district birth centres vs. women in St Louis delivered mainly by midwives in hospital | 3,777 pregnant women 3,689 deliveries 3,476 live births | 1:low; 2:medium; 3:high; 4:unclear | 874 | 151 | 5·84 (1·66 to 20·53) |
Greenwood 1990[31] rural Gambia | Prospective cohort | TBA training, village health worker support and obstetric pack vs. no additional care | 1,963 pregnancies | 1:low; 2:medium; 3:medium; 4:unclear | 1051 | 963 | 1·09 (0·43 to 2·75) |
Fauveau 1991; Maine 1996[23, 32] rural, Bangladesh (Matlab) | Prospective cohort 1987–1989 | Midwives working with community health workers and TBAs to attend home births, manage obstetric complications and accompany referral cases to project clinic vs. routine care (not described) plus access to project clinic | 9,630 live births | 1:low; 2:low; 3:unclear; 4:unclear | 136 | 388 | 0·35 (0·13 to 0·93) |
Ronsmans 1997[24] rural Bangladesh (Matlab) | Prospective cohort 1990–1993 | Access to above Matlab Intervention vs. "routine care" | 24,059 live births | 1:low; 2:low; 3:unclear; 4:unclear | 239 | 289 | 0·83 (0·5 to 1·36) |
Foord 1995; Fox-Rushby & Foord 1995, 1996. [33–35] The Gambia | Prospective cohort | Early identification of pregnant women by trained TBAs, mobile antenatal unit to treat anaemia and infections; referral/transfer for obstetric emergency treatment; low-cost insurance scheme to pay for treatment vs. care by TBAs with minimal tertiary facilities | 1,059 women delivering | 1:low; 2:low; 3:low; 4:unclear | 126 | 693 | 0·43 (0·02 to 1·55) |
Xu 1995[36] China | Prospective cohort | Reorganisation of maternity care to include better clinical governance, education and training of staff, and some community education | unknown | 1:low; 2:unclear; 3:low; 4:unclear | 37 | 93 | 0·39 |
Zhang 2004[37] China | Cohort: Complex stratification of "randomly selected" project and matched non-project areas | Maternal and child health providers at grass roots level given two weeks theory training; some also given one month clinical skills training | unknown | 1:low; 2:unclear; 3:low; 4:unclear | 53 | 52 | 1·06 |