Syst Rev. 2016 Aug 15;5(1):137. doi: 10.1186/s13643-016-0305-6.
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- 1African
Population Health Research Center, 2nd Floor, APHRC Campus, Manga
Close, Off Kirawa Road, Kitisuru, P. O. Box 10787, Nairobi, 00100,
Kenya. fwekesah@aphrc.org.
- 2Julius Global Health,
Julius Center for Health Sciences and Primary Care, Utrecht Medical
Center, Utrecht Huispost Str. 6.131, P.O. Box 85500, 3508 GA, Utrecht,
Netherlands. fwekesah@aphrc.org.
- 3African Population
Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa
Road, Kitisuru, P. O. Box 10787, Nairobi, 00100, Kenya.
- 4Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
- 5Department
of Public Health, School of Public Health and Family Health, College of
Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre,
Malawi.
- 6African Center for Public Health and Herbal Medicine, University of Malawi, Blantyre, Malawi.
Abstract
BACKGROUND:
Many
interventions have been implemented to improve maternal health outcomes
in sub-Saharan Africa (SSA). Currently, however, systematic information
on the effectiveness of these interventions remains scarce. We
conducted a systematic review of published evidence on non-drug
interventions that reported effectiveness in improving outcomes and
quality of care in maternal health in SSA.
METHODS:
African
Journals Online, Bioline, MEDLINE, Ovid, Science Direct, and Scopus
databases were searched for studies published in English between 2000
and 2015 and reporting on the effectiveness of interventions to improve
quality and outcomes of maternal health care in SSA. Articles focusing
on interventions that involved drug treatments, medications, or
therapies were excluded. We present a narrative synthesis of the
reported impact of these interventions on maternal morbidity and
mortality outcomes as well as on other dimensions of the quality of
maternal health care (as defined by the Institute of Medicine 2001 to
comprise safety, effectiveness, efficiency, timeliness, patient
centeredness, and equitability).
RESULTS:
Seventy-three
studies were included in this review. Non-drug interventions that
directly or indirectly improved quality of maternal health and morbidity
and mortality outcomes in SSA assumed a variety of forms including
mobile and electronic health, financial incentives on the demand and
supply side, facility-based clinical audits and maternal death reviews,
health systems strengthening interventions, community mobilization
and/or peer-based programs, home-based visits, counseling and health
educational and promotional programs conducted by health care providers,
transportation and/or communication and referrals for emergency
obstetric care, prevention of mother-to-child transmission of HIV, and
task shifting interventions. There was a preponderance of single
facility and community-based studies whose effectiveness was difficult
to assess.
CONCLUSIONS:
Many
non-drug interventions have been implemented to improve maternal health
care in SSA. These interventions have largely been health facility
and/or community based. While the evidence on the effectiveness of
interventions to improve maternal health is varied, study findings
underscore the importance of implementing comprehensive interventions
that strengthen different components of the health care systems, both in
the community and at the health facilities, coupled with a supportive
policy environment.
SYSTEMATIC REVIEW REGISTRATION:
PROSPERO CRD42015023750.
KEYWORDS:
Effectiveness;
Emergency obstetric care; Interventions; Maternal health care;
Morbidity; Mortality; Quality; Review; Sub-Saharan Africa