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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.


Funnel plot of studies linking the three stages of the time dimension (antenatal care, skilled birth attendance, and postnatal care) and the three stages of the space dimension (community-family care, outpatient-outreach care, and clinical care).
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pone.0139288.g007: Funnel plot of studies linking the three stages of the time dimension (antenatal care, skilled birth attendance, and postnatal care) and the three stages of the space dimension (community-family care, outpatient-outreach care, and clinical care).

Mentions: Six randomized studies linked the three stages of the time dimension (antenatal care, skilled birth attendance, and postnatal care) and the three stages of the space dimension (community–family care, outpatient–outreach care, and clinical care). According to the meta-analysis results including those studies, we observed significant reductions for neonatal mortality (RR 0.88; 95% CI 0.79 to 0.97, random effects [six studies] I2 67%, P < 0.01) and perinatal mortality (RR 0.78; 95% CI 0.66 to 0.92, random effects [five studies] I2 90%, P < 0.01). However, we did not observe significant reductions in maternal mortality (RR 0.94; 95% CI 0.49 to 1.83, random effects [three studies] I2 76%, P = 0.02). A composite measure of mortality was also significantly reduced (RR 0.85; 95% CI 0.77 to 0.93, random-effects, I2 81%, P < 0.01) (Fig 6). We did not find any obvious asymmetry in the funnel plot (Fig 7).


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)

Funnel plot of studies linking the three stages of the time dimension (antenatal care, skilled birth attendance, and postnatal care) and the three stages of the space dimension (community-family care, outpatient-outreach care, and clinical care).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0139288.g007: Funnel plot of studies linking the three stages of the time dimension (antenatal care, skilled birth attendance, and postnatal care) and the three stages of the space dimension (community-family care, outpatient-outreach care, and clinical care).
Mentions: Six randomized studies linked the three stages of the time dimension (antenatal care, skilled birth attendance, and postnatal care) and the three stages of the space dimension (community–family care, outpatient–outreach care, and clinical care). According to the meta-analysis results including those studies, we observed significant reductions for neonatal mortality (RR 0.88; 95% CI 0.79 to 0.97, random effects [six studies] I2 67%, P < 0.01) and perinatal mortality (RR 0.78; 95% CI 0.66 to 0.92, random effects [five studies] I2 90%, P < 0.01). However, we did not observe significant reductions in maternal mortality (RR 0.94; 95% CI 0.49 to 1.83, random effects [three studies] I2 76%, P = 0.02). A composite measure of mortality was also significantly reduced (RR 0.85; 95% CI 0.77 to 0.93, random-effects, I2 81%, P < 0.01) (Fig 6). We did not find any obvious asymmetry in the funnel plot (Fig 7).

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.