Abstract
Background: Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. Methods. This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods - before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Results: Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018). Conclusion: The continuum of care approach provided through the integration of service delivery modes decreased the perinatal mortality rate within a short period of time. Further testing of this model is warranted within the government health system in Bangladesh and other low-income countries.
| Original language | English (US) |
|---|---|
| Article number | 914 |
| Journal | BMC Public Health |
| Volume | 11 |
| DOIs | |
| State | Published - 2011 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
Cite this
Effectiveness of an integrated approach to reduce perinatal mortality : Recent experiences from Matlab, Bangladesh. / Rahman, Anisur; Moran, Allisyn; Pervin, Jesmin; Rahman, Aminur; Rahman, Monjur; Yeasmin, Sharifa; Begum, Hosneara; Rashid, Harunor; Yunus, Mohammad; Hruschka, Daniel; Arifeen, Shams E.; Streatfield, Peter K.; Sibley, Lynn; Bhuiya, Abbas; Koblinsky, Marge.
In: BMC Public Health, Vol. 11, 914, 2011.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effectiveness of an integrated approach to reduce perinatal mortality
T2 - Recent experiences from Matlab, Bangladesh
AU - Rahman, Anisur
AU - Moran, Allisyn
AU - Pervin, Jesmin
AU - Rahman, Aminur
AU - Rahman, Monjur
AU - Yeasmin, Sharifa
AU - Begum, Hosneara
AU - Rashid, Harunor
AU - Yunus, Mohammad
AU - Hruschka, Daniel
AU - Arifeen, Shams E.
AU - Streatfield, Peter K.
AU - Sibley, Lynn
AU - Bhuiya, Abbas
AU - Koblinsky, Marge
PY - 2011
Y1 - 2011
N2 - Background: Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. Methods. This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods - before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Results: Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018). Conclusion: The continuum of care approach provided through the integration of service delivery modes decreased the perinatal mortality rate within a short period of time. Further testing of this model is warranted within the government health system in Bangladesh and other low-income countries.
AB - Background: Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. Methods. This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods - before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Results: Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018). Conclusion: The continuum of care approach provided through the integration of service delivery modes decreased the perinatal mortality rate within a short period of time. Further testing of this model is warranted within the government health system in Bangladesh and other low-income countries.
UR - http://www.scopus.com/inward/record.url?scp=83055187851&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=83055187851&partnerID=8YFLogxK
U2 - 10.1186/1471-2458-11-914
DO - 10.1186/1471-2458-11-914
M3 - Article
C2 - 22151276
AN - SCOPUS:83055187851
VL - 11
JO - BMC Public Health
JF - BMC Public Health
SN - 1471-2458
M1 - 914
ER -