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Table 2 Characteristics and maternal mortality outcomes of included studies

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,
Dumont, 2002[29, 30]
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. [3335]
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
  1. Quality assessment codes: 1 = selection bias; 2 = performance bias; 3 = measurement bias; 4 = attrition bias
  2. TBA: Traditional birth attendant
  3. MMR: maternal mortality ratio (deaths/100,000 live births)