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Effective Linkages of Continuum of Care for Improving Neonatal, Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis.

Kikuchi K, Ansah EK, Okawa S, Enuameh Y, Yasuoka J, Nanishi K, Shibanuma A, Gyapong M, Owusu-Agyei S, Oduro AR, Asare GQ, Hodgson A, Jimba M, Ghana EMBRACE Implementation Research Project Te - PLoS ONE (2015)

Bottom Line: However, it is unclear which linkages of care could have a greater effect on MNCH outcomes.The review was conclusive for the reduction of neonatal and perinatal deaths.Although maternal deaths were not significantly reduced, composite measures of all mortality were.

View Article: PubMed Central - PubMed

Affiliation: Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Tokyo, Japan.

ABSTRACT

Background: Continuum of care has the potential to improve maternal, newborn, and child health (MNCH) by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood) and space dimensions (from community-family care to clinical care). However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries.

Methods: We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers' uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality.

Results: Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I2 79%). Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I2 81%).

Conclusions: Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The review was conclusive for the reduction of neonatal and perinatal deaths. Although maternal deaths were not significantly reduced, composite measures of all mortality were. Thus, the evidence is sufficient to scale up this intervention package for the improvement of MNCH outcomes.

No MeSH data available.


Number of studies in each category of continuum of care linkage.
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pone.0139288.g002: Number of studies in each category of continuum of care linkage.

Mentions: As shown in Fig 2, out of the 19 studies, 13 involved interventions that linked antenatal care, skilled birth attendance, and postnatal care [53, 54, 56, 59, 61, 63, 65–69]. One study each linked antenatal care and skilled birth attendance [64] or skilled birth attendance and postnatal care [58]. Four studies linked antenatal care and postnatal care [55, 57, 60, 62]. However, no study used interventions that linked all the time stages as recommended—namely, four antenatal care visits; skilled birth attendance; and postnatal care within 48 hours, at seven days, and at six weeks.


Effective Linkages of Continuum of Care for Improving Neonatal, Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis.

Kikuchi K, Ansah EK, Okawa S, Enuameh Y, Yasuoka J, Nanishi K, Shibanuma A, Gyapong M, Owusu-Agyei S, Oduro AR, Asare GQ, Hodgson A, Jimba M, Ghana EMBRACE Implementation Research Project Te - PLoS ONE (2015)

Number of studies in each category of continuum of care linkage.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4589290&req=5

pone.0139288.g002: Number of studies in each category of continuum of care linkage.
Mentions: As shown in Fig 2, out of the 19 studies, 13 involved interventions that linked antenatal care, skilled birth attendance, and postnatal care [53, 54, 56, 59, 61, 63, 65–69]. One study each linked antenatal care and skilled birth attendance [64] or skilled birth attendance and postnatal care [58]. Four studies linked antenatal care and postnatal care [55, 57, 60, 62]. However, no study used interventions that linked all the time stages as recommended—namely, four antenatal care visits; skilled birth attendance; and postnatal care within 48 hours, at seven days, and at six weeks.

Bottom Line: However, it is unclear which linkages of care could have a greater effect on MNCH outcomes.The review was conclusive for the reduction of neonatal and perinatal deaths.Although maternal deaths were not significantly reduced, composite measures of all mortality were.

View Article: PubMed Central - PubMed

Affiliation: Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Tokyo, Japan.

ABSTRACT

Background: Continuum of care has the potential to improve maternal, newborn, and child health (MNCH) by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood) and space dimensions (from community-family care to clinical care). However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries.

Methods: We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers' uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality.

Results: Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I2 79%). Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I2 81%).

Conclusions: Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The review was conclusive for the reduction of neonatal and perinatal deaths. Although maternal deaths were not significantly reduced, composite measures of all mortality were. Thus, the evidence is sufficient to scale up this intervention package for the improvement of MNCH outcomes.

No MeSH data available.