The Effectiveness of Emergency Obstetric Referral Interventions in Developing Country Settings: A Systematic Review
Background:
Pregnancy complications can be unpredictable and many women in developing countries cannot access health facilities where life-saving care is available. This study assesses the effects of referral interventions that enable pregnant women to reach health facilities during an emergency, after the decision to seek care is made.
Methods and findings:
Selected bibliographic databases were searched with no date or language restrictions. Randomised controlled trials and quasi experimental study designs with a comparison group were included. Outcomes of interest included maternal and neonatal mortality and other intermediate measures such as service utilisation. Two reviewers independently selected, appraised, and extracted articles using predefined fields. Forest plots, tables, and qualitative summaries of study quality, size, and direction of effect were used for analysis.
Nineteen studies were included. In South Asian settings, four studies of organisational interventions in communities that generated funds for transport reduced neonatal deaths, with the largest effect seen in India (odds ratio 0·48 95% CI 0·34–0·68). Three quasi experimental studies from sub-Saharan Africa reported reductions in stillbirths with maternity waiting home interventions, with one statistically significant result (OR 0.56 95% CI 0.32–0.96). Effects of interventions on maternal mortality were unclear. Referral interventions usually improved utilisation of health services but the opposite effect was also documented. The effects of multiple interventions in the studies could not be disentangled. Explanatory mechanisms through which the interventions worked could not be ascertained.
Conclusions:
Community mobilisation interventions may reduce neonatal mortality but the contribution of referral components cannot be ascertained. The reduction in stillbirth rates resulting from maternity waiting homes needs further study. Referral interventions can have unexpected adverse effects. To inform the implementation of effective referral interventions, improved monitoring and evaluation practices are necessary, along with studies that develop better understanding of how interventions work.
: Please see later in the article for the Editors' Summary
Vyšlo v časopise:
The Effectiveness of Emergency Obstetric Referral Interventions in Developing Country Settings: A Systematic Review. PLoS Med 9(7): e32767. doi:10.1371/journal.pmed.1001264
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001264
Souhrn
Background:
Pregnancy complications can be unpredictable and many women in developing countries cannot access health facilities where life-saving care is available. This study assesses the effects of referral interventions that enable pregnant women to reach health facilities during an emergency, after the decision to seek care is made.
Methods and findings:
Selected bibliographic databases were searched with no date or language restrictions. Randomised controlled trials and quasi experimental study designs with a comparison group were included. Outcomes of interest included maternal and neonatal mortality and other intermediate measures such as service utilisation. Two reviewers independently selected, appraised, and extracted articles using predefined fields. Forest plots, tables, and qualitative summaries of study quality, size, and direction of effect were used for analysis.
Nineteen studies were included. In South Asian settings, four studies of organisational interventions in communities that generated funds for transport reduced neonatal deaths, with the largest effect seen in India (odds ratio 0·48 95% CI 0·34–0·68). Three quasi experimental studies from sub-Saharan Africa reported reductions in stillbirths with maternity waiting home interventions, with one statistically significant result (OR 0.56 95% CI 0.32–0.96). Effects of interventions on maternal mortality were unclear. Referral interventions usually improved utilisation of health services but the opposite effect was also documented. The effects of multiple interventions in the studies could not be disentangled. Explanatory mechanisms through which the interventions worked could not be ascertained.
Conclusions:
Community mobilisation interventions may reduce neonatal mortality but the contribution of referral components cannot be ascertained. The reduction in stillbirth rates resulting from maternity waiting homes needs further study. Referral interventions can have unexpected adverse effects. To inform the implementation of effective referral interventions, improved monitoring and evaluation practices are necessary, along with studies that develop better understanding of how interventions work.
: Please see later in the article for the Editors' Summary
Zdroje
1. AbouZahrC 1998 Antepartum and postpartum hemorrhage. Chapter 4. Murray C, Lopez A, editors. Health dimensions of sex and reproduction Boston Harvard School of Public Health
2. KhanRUEl-RafaeyH 2006 Pathophysiology of post partum haemorrhage and third stage of labour Chapter 8. B-LynchCKeithLGLalondeABKaroshiM A textbook of post partum haemorrhage London Sapiens publishing 62 69
3. UNICEF 2009 State of the world's children New York UNICEF
4. NyamtemaASUrassaDPvan RoosmalenJ 2011 Maternal health interventions in resource limited countries: a systematic review of packages, impacts and factors for change. BMC Pregnancy Childbirth 11 30
5. ThaddeusSMaineD 1994 Too far to walk: maternal mortality in context. Soc Sc Med 38(8) 1091 1110
6. JahnAde BrouwereV 2001 Referral in pregnancy and childbirth: concepts and strategies. Available: http://www.jsieurope.org/safem/collect/safem/pdf/s2940e/s2940e.pdf Accessed 29 December 2011
7. World Bank 2011 Country and lending groups. Available: http://data.worldbank.org/about/country-classifications/country-and-lending-groups Accessed 29 December 2011
8. Effective Public Health Practice Project 2009 Quality assessment tool. Available: http://www.ephpp.ca/Tools.html Accessed 29 December 2011
9. WalterINutleySDaviesH 2003 Developing a taxonomy of interventions used to increase the impact of research: Appendix I. Available: http://www.ruru.ac.uk/PDFs/Taxonomy%20development%20paper%20070103.pdf Accessed 29 December 2011
10. AzadKBarnettSBanerjeeBShahaSKhanK 2010 Effects of scaling up women's groups on birth outcomes in three rural districts in Bangladesh: a cluster randomised trial. Lancet 375 1193 1202
11. BaileyPSzaszdiJGloverL 2002 Obstetric complications: does training traditional birth attendants make a difference? Pan Am J Public Health 11 15 23
12. BhuttaZMemonZSoofiSSalatMCousensS 2008 Implementing community-based perinatal care: results from pilot study in rural Pakistan. Bull World Health Organ 86 452 459
13. HossainJRossS 2006 The effect of addressing demand for as well as supply of emergency obstetric care in Dinajpur, Bangladesh. Int J Gynecol Obstet 92 320 328
14. BarbeyAFaiselAMyeyaJStavrouVStewartJ 2001 Dinajpur SafeMother Initiative: final evaluation report. Available: http://webtest.dhaka.net/care/publication/Publication_6871971.pdf. Accessed 29 December 2011
15. KumarVMohantySKumarAMisraRPSantoshamM 2008 Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial. Lancet 372 1151 1162
16. ManandharDSOsrinDShresthaBPMeskoNMorrisonJ 2004 Effect of a participatory intervention with women's groups on birth outcomes in Nepal: cluster-randomised controlled trial. Lancet 364 970 979
17. AlisjahbanaAWilliamsCDharmayantiRHermawanDKwastB 1995 An integrated village maternity service to improve referral patterns in a rural area in West Java. Int J Gynecol Obstet 48 Suppl. S83 S94
18. BrazierEAndrzejewskiCPerkinsMThemmenEKnightR 2009 Improving poor women's access to maternity care: findings from a primary care intervention in Burkina Faso. Soc Sc Med 69 682 690
19. FCI Family Care International Burkina Faso 2007 Testing approaches for increasing skilled care during childbirth: key findings from Ouargaye, Burkina Faso. Available: http://www.familycareintl.org/UserFiles/File/SCI%20Burkina%20Faso%20Summary.pdf. Accessed 29 December 2011
20. ChandramohanDCuttsFChandraR 1994 Effects of a maternity waiting home on adverse maternal outcomes and the validity of antenatal risk screening. Int J Gynecol Obstet 46 279 284
21. ChandramohanDCuttsFMillardP 1995 The effect of stay in a maternity waiting home on perinatal mortality in rural Zimbabwe. J Trop Med Hyg 98 261 267
22. LonkhuijzenLStegemanMNyirongoRvan RoosmalenJ 2003 Use of maternity waiting home in rural Zambia. Afr J Reprod Health 7 32 36
23. LunguKKamfoseVHusseinJAshwood-SmithH 2001 Are bicycle ambulances and community transport plans effective in strengthening obstetric referral systems in Southern Malawi. Malawi Med J 13 16 18
24. MillardPBaileyJHansonJ 1991 Antenatal village stay and pregnancy outcome in rural Zimbabwe. Cent Afr J Med 37 1 4
25. TumwineJDungareP 1996 Maternity waiting shelters and pregnancy outcome: experience from a rural area in Zimbabwe. Ann Trop Paediatr 16 55 59
26. FauveauVStewartKKhanSChakrabortyJ 1991 Effect on mortality of community based maternity care programme in rural Bangladesh. Lancet 338 1183 1186
27. RonsmansCVannesteAChakrabortyJGinnekenJ 1997 Decline in maternal mortality in Matlab, Bangladesh: a cautionary tale. Lancet 350 1810 1814
28. MaineDAklinMChakrabortyJFranciscoAStrongM 1996 Why did maternal mortality decline in Matlab? Stud Fam Plann 27 179 187
29. KidneyEWinterHKhanKSGülmezogluAMMeadsCA 2009 Systematic review of effect of community level interventions to reduce maternal mortality. BMC Pregnancy Childbirth 9 2
30. LassiZSHaiderBABhuttaZA 2010 Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev 11 CD007754
31. LeeACCLawnJCousensSKumarVOsrinD 2009 Linking families and facilities for care at birth: what works to avert intrapartum-related deaths? Int J Gynecol Obstet 107 Suppl. S65 S88
32. LonkhuijzenLStekelenburgJvan RoosmalenJ 2009 Maternity waiting facilities for improving maternal and neonatal outcome in low-resource countries. Cochrane Database Syst Rev 3 CD006759
33. HolmesWKennedyE 2010 Reaching emergency obstetric care: overcoming the second delay. Melbourne: Burnet Institute Available: http://www.wchknowledgehub.com.au/our-resources Accessed 29 December 2011
34. MurraySFPearsonSC 2006 Maternity referral systems in developing countries: current knowledge and future research needs. Soc Sc Med 62 2205 2215
35. KrasovecK 2004 Auxiliary technologies related to transport and communication for obstetric emergencies. Int J Gynecol Obstet 85 S14 S23
36. MacintyreKHotchkissD 1999 Referral revisited: community financing schemes and emergency transport in rural Africa. Soc Sc Med 49 1473 1487
37. GoldieSSweetSCarvalhoNNatchuUHuD 2010 Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis. PLoS Med 7 e1000264 doi:10.1371.journal.pmed.1000264
38. PilkingtonKBoshnakovaAClarkeMRichardsonJ 2005 No language restrictions in database searches: what does this really mean? J Altern Complement Med 11 205 207
39. WhitingPWestwoodMBurkeMSterneJGlanvilleJ 2008 Systematic reviews of test accuracy should search a range of databases to identify primary studies. J Clin Epid 61 357 364
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