A comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 2. maternal health findings

Mary Jennings, Subarna Pradhan, Meike Schleiff, Emma Sacks, Paul A. Freeman, Sundeep Gupta, Bahie M. Rassekh, Henry Baker Perry

Research output: Contribution to journalArticle

Abstract

Background We summarize the findings of assessments of projects, programs, and research studies (collectively referred to as projects) included in a larger review of the effectiveness of community-based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH). Findings on neonatal and child health are reported elsewhere in this series. Methods We searched PUBMED and other databases through December 2015, and included assessments that underwent data extraction. Data were analyzed to identify themes in interventions implemented, health outcomes, and strategies used in implementation. Results 152 assessments met inclusion criteria. The majority of assessments were set in rural communities. 72% of assessments included 1-10 specific interventions aimed at improving maternal health. A total of 1298 discrete interventions were assessed. Outcome measures were grouped into five main categories: maternal mortality (19% of assessments); maternal morbidity (21%); antenatal care attendance (50%); attended delivery (66%) and facility delivery (69%), with many assessments reporting results on multiple indicators. 15 assessment reported maternal mortality as a primary outcome, and of the seven that performed statistical testing, six reported significant decreases. Seven assessments measured changes in maternal morbidity: postpartum hemorrhage, malaria or eclampsia. Of those, six reported significant decreases and one did not find a significant effect. Assessments of community-based interventions on antenatal care attendance, attended delivery and facility-based deliveries all showed a positive impact. The community-based strategies used to achieve these results often involved community collaboration, home visits, formation of participatory women's groups, and provision of services by outreach teams from peripheral health facilities. Conclusions This comprehensive and systematic review provides evidence of the effectiveness of CBPHC in improving key indicators of maternal morbidity and mortality. Most projects combined community- and facility-based approaches, emphasizing potential added benefits from such holistic approaches. Community-based interventions will be an important component of a comprehensive approach to accelerate improvements in maternal health and to end preventable maternal deaths by 2030.

Original languageEnglish (US)
Article number010902
JournalJournal of Global Health
Volume7
Issue number1
DOIs
StatePublished - 2017

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Primary Health Care
Maternal Mortality
Prenatal Care
Morbidity
Mothers
Postpartum Hemorrhage
Eclampsia
Maternal Death
House Calls
Health Facilities
Rural Population
Infant Health
Maternal Health
Child Health
Malaria
Outcome Assessment (Health Care)
Databases
Health
Research

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

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A comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health : 2. maternal health findings. / Jennings, Mary; Pradhan, Subarna; Schleiff, Meike; Sacks, Emma; Freeman, Paul A.; Gupta, Sundeep; Rassekh, Bahie M.; Perry, Henry Baker.

In: Journal of Global Health, Vol. 7, No. 1, 010902, 2017.

Research output: Contribution to journalArticle

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abstract = "Background We summarize the findings of assessments of projects, programs, and research studies (collectively referred to as projects) included in a larger review of the effectiveness of community-based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH). Findings on neonatal and child health are reported elsewhere in this series. Methods We searched PUBMED and other databases through December 2015, and included assessments that underwent data extraction. Data were analyzed to identify themes in interventions implemented, health outcomes, and strategies used in implementation. Results 152 assessments met inclusion criteria. The majority of assessments were set in rural communities. 72{\%} of assessments included 1-10 specific interventions aimed at improving maternal health. A total of 1298 discrete interventions were assessed. Outcome measures were grouped into five main categories: maternal mortality (19{\%} of assessments); maternal morbidity (21{\%}); antenatal care attendance (50{\%}); attended delivery (66{\%}) and facility delivery (69{\%}), with many assessments reporting results on multiple indicators. 15 assessment reported maternal mortality as a primary outcome, and of the seven that performed statistical testing, six reported significant decreases. Seven assessments measured changes in maternal morbidity: postpartum hemorrhage, malaria or eclampsia. Of those, six reported significant decreases and one did not find a significant effect. Assessments of community-based interventions on antenatal care attendance, attended delivery and facility-based deliveries all showed a positive impact. The community-based strategies used to achieve these results often involved community collaboration, home visits, formation of participatory women's groups, and provision of services by outreach teams from peripheral health facilities. Conclusions This comprehensive and systematic review provides evidence of the effectiveness of CBPHC in improving key indicators of maternal morbidity and mortality. Most projects combined community- and facility-based approaches, emphasizing potential added benefits from such holistic approaches. Community-based interventions will be an important component of a comprehensive approach to accelerate improvements in maternal health and to end preventable maternal deaths by 2030.",
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