Broad syntheses related to this topic

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Broad synthesis / Overview of systematic reviews

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Community mobilization to strengthen support for appropriate and timely use of antenatal and postnatal care: A review of reviews.

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Journal Journal of global health
Year 2021
Links Pubmed DOI PubMed Central

This article includes 12 Systematic reviews Systematic reviews (12 references)

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BACKGROUND: Antenatal care (ANC) and postnatal care (PNC) are critical opportunities for women, babies and parents/families to receive quality care and support from health services. Community-based interventions may improve the accessibility, availability, and acceptance of this vital care. For example, community mobilization strategies have been used to involve and collaborate with women, families and communities to improve maternal and newborn health. OBJECTIVE: To synthesize existing reviews of evidence on community mobilization strategies that strengthen support for appropriate and timely use of ANC and PNC. METHODS: Six databases (MEDLINE, Embase, CINAHL, PsychINFO, Cochrane Library, PROSPERO) were searched for published reviews that describe community mobilization related strategies for ANC and/or PNC. Reviews were eligible for inclusion if they described any initiatives or strategies targeting the promotion of ANC and/or PNC uptake that included an element of community mobilization in a low- or middle-income country (LMIC), published after 2000. Included reviews were critically appraised according to the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Evidence Syntheses. This review of reviews was conducted following JBI guidelines for undertaking and reporting umbrella reviews. RESULTS: In total 23 papers, representing 22 reviews were included. While all 22 reviews contained some description of community mobilization and ANC/PNC, 13 presented more in-depth details on the community mobilization processes and relevant outcomes. Seventeen reviews focused on ANC, four considered both ANC and PNC, and only one focused on PNC. Overall, 16 reviews reported at least one positive association between community mobilization activities and ANC/PNC uptake, while five reviews presented primary studies with no statistically significant change in ANC uptake and one included a primary study with a decrease in use of antenatal facilities. The community mobilization activities described by the reviews ranged from informative, passive communication to more active, participatory approaches that included engaging individuals or consulting local leaders and community members to develop priorities and action plans. CONCLUSIONS: While there is considerable momentum around incorporating community mobilization activities in maternal and newborn health programs, such as improving community support for the uptake of ANC and PNC, there is limited evidence on the processes used. Furthermore, the spectrum of terminology and variation in definitions should be harmonized to guide the implementation and evaluation efforts.

Broad synthesis

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More money for HRH: More HRH for the money

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Authors GHWA
Report GHWA
Year 2012
Links http://www.who.int/workforcealliance/knowledge/resources/hrhfinancingbrief2012/en/index.html

This article includes 1 Systematic review Systematic reviews (1 reference) 6 Primary studies Primary studies (6 references)

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Health costs are spiralling out of control all over the world in context of global financial crisis while some countries are still struggling to offer basic health services. The health sector in Sub-Saharan Africa is most often unfunded, including the health workforce, which represents the single largest item in health budgets. On the other hand, countries do not meet the minimum health staffing levels to provide essential care. Ministries of Finance and Health need to jointly identify and allocate additional financial resources - for HRH - to maximize the efficiency and effectiveness of current capital and recurrent expenditures.

Broad synthesis

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Access to health: How to reduce child and maternal mortality?

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Journal 3ie Brief
Year 2010
Links 3ie Policy Briefs 3ieimpact.org

This article includes 13 Primary studies Primary studies (13 references) 4 Systematic reviews Systematic reviews (4 references)

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Systematic reviews show that access to community-based health services reduces neonatal mortality and still births, but t he effect on maternal mortality is harder to detect. However, the evidence so fr has come from small sample size studies, mainly conducted in Asia and with very little information from Sub-Saharan Africa and Latin America. Only a few studies assess Maternal Neonatal and Child Health (MNCH) services at the community level, and focus on interventions at the level of primary care. More large scale research factoring in specific contexts is particularly needed. Additional investigation on the cost-effectiveness of health services is also required and will help in promoting and scaling up community-based interventions for maternal and newborn care.

Broad synthesis / Policy brief

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Policy brief on improving access to artemisinin-based combination therapies for malaria in Mozambique.

Journal International journal of technology assessment in health care
Year 2010
Links Pubmed DOI

This article includes 6 Primary studies Primary studies (6 references) 1 Broad synthesis Broad syntheses (1 reference) 5 Systematic reviews Systematic reviews (5 references)

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Broad synthesis

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Obstetric care in low-resource settings: what, who, and how to overcome challenges to scale up?

Journal International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
Year 2009
Links Pubmed DOI

This article includes 26 Systematic reviews Systematic reviews (26 references) 45 Primary studies Primary studies (45 references)

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BACKGROUND: Each year, approximately 2 million babies die because of complications of childbirth, primarily in settings where effective care at birth, particularly prompt cesarean delivery, is unavailable. OBJECTIVE: We reviewed the content, impact, risk-benefit, and feasibility of interventions for obstetric complications with high population attributable risk of intrapartum-related hypoxic injury, as well as human resource, skill development, and technological innovations to improve obstetric care quality and availability. RESULTS: Despite ecological associations of obstetric care with improved perinatal outcomes, there is limited evidence that intrapartum interventions reduce intrapartum-related neonatal mortality or morbidity. No interventions had high-quality evidence of impact on intrapartum-related outcomes in low-resource settings. While data from high-resource settings support planned cesarean for breech presentation and post-term induction, these interventions may be unavailable or less safe in low-resource settings and require risk-benefit assessment. Promising interventions include use of the partograph, symphysiotomy, amnioinfusion, therapeutic maneuvers for shoulder dystocia, improved management of intra-amniotic infections, and continuous labor support. Obstetric drills, checklists, and innovative low-cost devices could improve care quality. Task-shifting to alternative cadres may increase coverage of care. CONCLUSIONS: While intrapartum care aims to avert intrapartum-related hypoxic injury, rigorous evidence is lacking, especially in the settings where most deaths occur. Effective care at birth could save hundreds of thousands of lives a year, with investment in health infrastructure, personnel, and research--both for innovation and to improve implementation.

Broad synthesis

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Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence.

Journal Pediatrics
Year 2005
Links Pubmed DOI

This article is included in 1 Broad synthesis Broad syntheses (1 reference)

This article includes 74 Primary studies Primary studies (74 references) 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developing-country communities has not been reported. OBJECTIVE: This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in community-based neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning. METHODS: Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies. RESULTS: A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care. CONCLUSIONS: This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy makers about the importance of investing in neonatal health.