Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia
Abstract Background This is a systematic review on the effectiveness of community interventions in improving maternal health care outcomes in South Asia. Methods We searched electronic databases to June 2017. Randomised or cluster randomised studies in communities within rural/remote areas of Nepal,...
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| Format: | Article |
| Language: | English |
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BMC
2018-08-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | http://link.springer.com/article/10.1186/s12884-018-1964-1 |
| _version_ | 1818408337183604736 |
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| author | Binod Bindu Sharma Lisa Jones Deborah Joanne Loxton Debbie Booth Roger Smith |
| author_facet | Binod Bindu Sharma Lisa Jones Deborah Joanne Loxton Debbie Booth Roger Smith |
| author_sort | Binod Bindu Sharma |
| collection | DOAJ |
| description | Abstract Background This is a systematic review on the effectiveness of community interventions in improving maternal health care outcomes in South Asia. Methods We searched electronic databases to June 2017. Randomised or cluster randomised studies in communities within rural/remote areas of Nepal, Bangladesh, India and Pakistan were included. Data were analysed as risk ratios (RR) or odds ratios (OR), and effects were adjusted for clustering. Meta-analyses were performed using random-effects and evidence quality was assessed. Results Eleven randomised trials were included from 5440 citations. Meta-analysis of all community interventions combined compared with control showed a small improvement in the number of women attending at least one antenatal care visit (RR 1.19, 95% CI 1.06 to 1.33). Two community mobilisation sub groups: home care using both male and female mobilisers, and education by community mobilisers, improved the number of women attending at least one antenatal visit. There was no difference in the number of women attending at least one antenatal visit for any other subgroup. There was no difference in the number of women attending 3 or more antenatal visits for all community interventions combined, or any community subgroup. Likewise, there was no difference in attendance at birth between all community interventions combined and control. Health care facility births were modestly increased in women’s education groups (adjusted RR (1.15, 95% CI 1.11 to 1.20; 2 studies)). Risk of maternal deaths after 2 years (RR 0.63, 95% CI 0.24 to 1.64; 5 studies), and 3 years (RR 1.11, 95% CI 0.52 to 2.36; 2 studies), were no different between women’s education groups and control. Community level mobilisation rather than health care messages at district level improved the numbers of women giving birth at health care facilities (RR1.09 (95%CI 1.06 to 1.13; 1 study)). Maternal health care knowledge scores improved in two community-based interventions, one involving education of male community members. Conclusion Women’s education interventions may improve the number of women seeking birth at a health care facility, but the evidence is of low quality. No impact on maternal mortality was observed Future research should explore the effectiveness of including male mobilisers. Trial registration This systematic review is registered with PROSPERO CRD42016033201. |
| first_indexed | 2024-12-14T09:42:07Z |
| format | Article |
| id | doaj.art-e82b4afa021845319c7ac2a0ca8f8275 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-14T09:42:07Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-e82b4afa021845319c7ac2a0ca8f82752022-12-21T23:07:45ZengBMCBMC Pregnancy and Childbirth1471-23932018-08-0118111610.1186/s12884-018-1964-1Systematic review of community participation interventions to improve maternal health outcomes in rural South AsiaBinod Bindu Sharma0Lisa Jones1Deborah Joanne Loxton2Debbie Booth3Roger Smith4Mothers and Babies Research Centre, Hunter Medical Research InstituteDepartment of Neonatology, John Hunter HospitalPriority Research Centre for Generational Health and Ageing, The University of NewcastleThe University of NewcastleMothers and Babies Research Centre, Hunter Medical Research InstituteAbstract Background This is a systematic review on the effectiveness of community interventions in improving maternal health care outcomes in South Asia. Methods We searched electronic databases to June 2017. Randomised or cluster randomised studies in communities within rural/remote areas of Nepal, Bangladesh, India and Pakistan were included. Data were analysed as risk ratios (RR) or odds ratios (OR), and effects were adjusted for clustering. Meta-analyses were performed using random-effects and evidence quality was assessed. Results Eleven randomised trials were included from 5440 citations. Meta-analysis of all community interventions combined compared with control showed a small improvement in the number of women attending at least one antenatal care visit (RR 1.19, 95% CI 1.06 to 1.33). Two community mobilisation sub groups: home care using both male and female mobilisers, and education by community mobilisers, improved the number of women attending at least one antenatal visit. There was no difference in the number of women attending at least one antenatal visit for any other subgroup. There was no difference in the number of women attending 3 or more antenatal visits for all community interventions combined, or any community subgroup. Likewise, there was no difference in attendance at birth between all community interventions combined and control. Health care facility births were modestly increased in women’s education groups (adjusted RR (1.15, 95% CI 1.11 to 1.20; 2 studies)). Risk of maternal deaths after 2 years (RR 0.63, 95% CI 0.24 to 1.64; 5 studies), and 3 years (RR 1.11, 95% CI 0.52 to 2.36; 2 studies), were no different between women’s education groups and control. Community level mobilisation rather than health care messages at district level improved the numbers of women giving birth at health care facilities (RR1.09 (95%CI 1.06 to 1.13; 1 study)). Maternal health care knowledge scores improved in two community-based interventions, one involving education of male community members. Conclusion Women’s education interventions may improve the number of women seeking birth at a health care facility, but the evidence is of low quality. No impact on maternal mortality was observed Future research should explore the effectiveness of including male mobilisers. Trial registration This systematic review is registered with PROSPERO CRD42016033201.http://link.springer.com/article/10.1186/s12884-018-1964-1CommunityNetworksRuralPregnancyAntenatal careDelivery |
| spellingShingle | Binod Bindu Sharma Lisa Jones Deborah Joanne Loxton Debbie Booth Roger Smith Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia BMC Pregnancy and Childbirth Community Networks Rural Pregnancy Antenatal care Delivery |
| title | Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia |
| title_full | Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia |
| title_fullStr | Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia |
| title_full_unstemmed | Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia |
| title_short | Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia |
| title_sort | systematic review of community participation interventions to improve maternal health outcomes in rural south asia |
| topic | Community Networks Rural Pregnancy Antenatal care Delivery |
| url | http://link.springer.com/article/10.1186/s12884-018-1964-1 |
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