Limits...
Demand-side interventions for maternal care: evidence of more use, not better outcomes.

Hurst TE, Semrau K, Patna M, Gawande A, Hirschhorn LR - BMC Pregnancy Childbirth (2015)

Bottom Line: We found that demand-side interventions were effective in increasing uptake of key services with five CM and all seven FI interventions reporting increased use of maternal health services.No studies found a reduction in stillbirth rate.We found strong evidence that demand-side interventions are associated with increased utilization of services with more variable evidence of their impact on reducing early neonatal and maternal mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, USA. taylor.hurst@mail.harvard.edu.

ABSTRACT

Background: Reducing maternal and neonatal mortality is essential to improving population health. Demand-side interventions are designed to increase uptake of critical maternal health services, but associated change in service uptake and outcomes is varied. We undertook a literature review to understand current evidence of demand-side intervention impact on improving utilization and outcomes for mothers and newborn children.

Methods: We completed a rapid review of literature in PubMed. Title and abstracts of publications identified from selected search terms were reviewed to identify articles meeting inclusion criteria: demand-side intervention in low or middle-income countries (LMIC), published after September 2004 and before March 2014, study design describing and reporting on >1 priority outcome: utilization (antenatal care visits, facility-based delivery, delivery with a skilled birth attendant) or health outcome measures (maternal mortality ratio (MMR), stillbirth rate, perinatal mortality rate (PMR), neonatal mortality rate (NMR)). Bibliographies were searched to identify additional relevant papers. Articles were abstracted using a standardized data collection template with double extraction on a sample to ensure quality. Quality of included studies was assessed using McMaster University's Quality Assessment Tool from the Effective Public Health Practice Project (EPHPP).

Results: Five hundred and eighty two articles were screened with 50 selected for full review and 16 meeting extraction criteria (eight community mobilization interventions (CM), seven financial incentive interventions (FI), and one with both). We found that demand-side interventions were effective in increasing uptake of key services with five CM and all seven FI interventions reporting increased use of maternal health services. Association with health outcome measures were varied with two studies reporting reductions in MMR and four reporting reduced NMR. No studies found a reduction in stillbirth rate. Only four of the ten studies reporting on both utilization and outcomes reported improvement in both measures.

Conclusions: We found strong evidence that demand-side interventions are associated with increased utilization of services with more variable evidence of their impact on reducing early neonatal and maternal mortality. Further research is needed to understand how to maximize the potential of demand-side interventions to improve maternal and neonatal health outcomes including the role of quality improvement and coordination with supply-side interventions.

No MeSH data available.


Study review for inclusion
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4644345&req=5

Fig1: Study review for inclusion

Mentions: An initial search resulted in 582 articles (Fig. 1). Following review of titles and abstracts, 50 were selected for full review with 13 studies meeting criteria for extraction. Three additional studies [7–9] were identified from reviewing the references of the articles found in the search, resulting in 16 studies in the final analysis. Of these 16 studies, eight described community mobilization interventions, seven reported on financial incentive interventions, and one intervention included both financial incentives and community mobilization. Community mobilization interventions included participatory women’s groups, training of community facilitators, and community level health promotion. Financial incentive interventions included voucher schemes and conditional cash transfers, which involve the provision of money to a household or individual if specific, pre-determined conditions are met [10]. Interventions were implemented across a range of low and middle-income countries including: Bangladesh, Burkina Faso, Malawi, Cambodia, Kenya, Tanzania, Nepal, India, Vietnam, and Mexico. Nine of the interventions were implemented in rural settings, two in urban settings, and five spanned both rural and urban settings (Table 1).Fig. 1


Demand-side interventions for maternal care: evidence of more use, not better outcomes.

Hurst TE, Semrau K, Patna M, Gawande A, Hirschhorn LR - BMC Pregnancy Childbirth (2015)

Study review for inclusion
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4644345&req=5

Fig1: Study review for inclusion
Mentions: An initial search resulted in 582 articles (Fig. 1). Following review of titles and abstracts, 50 were selected for full review with 13 studies meeting criteria for extraction. Three additional studies [7–9] were identified from reviewing the references of the articles found in the search, resulting in 16 studies in the final analysis. Of these 16 studies, eight described community mobilization interventions, seven reported on financial incentive interventions, and one intervention included both financial incentives and community mobilization. Community mobilization interventions included participatory women’s groups, training of community facilitators, and community level health promotion. Financial incentive interventions included voucher schemes and conditional cash transfers, which involve the provision of money to a household or individual if specific, pre-determined conditions are met [10]. Interventions were implemented across a range of low and middle-income countries including: Bangladesh, Burkina Faso, Malawi, Cambodia, Kenya, Tanzania, Nepal, India, Vietnam, and Mexico. Nine of the interventions were implemented in rural settings, two in urban settings, and five spanned both rural and urban settings (Table 1).Fig. 1

Bottom Line: We found that demand-side interventions were effective in increasing uptake of key services with five CM and all seven FI interventions reporting increased use of maternal health services.No studies found a reduction in stillbirth rate.We found strong evidence that demand-side interventions are associated with increased utilization of services with more variable evidence of their impact on reducing early neonatal and maternal mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, USA. taylor.hurst@mail.harvard.edu.

ABSTRACT

Background: Reducing maternal and neonatal mortality is essential to improving population health. Demand-side interventions are designed to increase uptake of critical maternal health services, but associated change in service uptake and outcomes is varied. We undertook a literature review to understand current evidence of demand-side intervention impact on improving utilization and outcomes for mothers and newborn children.

Methods: We completed a rapid review of literature in PubMed. Title and abstracts of publications identified from selected search terms were reviewed to identify articles meeting inclusion criteria: demand-side intervention in low or middle-income countries (LMIC), published after September 2004 and before March 2014, study design describing and reporting on >1 priority outcome: utilization (antenatal care visits, facility-based delivery, delivery with a skilled birth attendant) or health outcome measures (maternal mortality ratio (MMR), stillbirth rate, perinatal mortality rate (PMR), neonatal mortality rate (NMR)). Bibliographies were searched to identify additional relevant papers. Articles were abstracted using a standardized data collection template with double extraction on a sample to ensure quality. Quality of included studies was assessed using McMaster University's Quality Assessment Tool from the Effective Public Health Practice Project (EPHPP).

Results: Five hundred and eighty two articles were screened with 50 selected for full review and 16 meeting extraction criteria (eight community mobilization interventions (CM), seven financial incentive interventions (FI), and one with both). We found that demand-side interventions were effective in increasing uptake of key services with five CM and all seven FI interventions reporting increased use of maternal health services. Association with health outcome measures were varied with two studies reporting reductions in MMR and four reporting reduced NMR. No studies found a reduction in stillbirth rate. Only four of the ten studies reporting on both utilization and outcomes reported improvement in both measures.

Conclusions: We found strong evidence that demand-side interventions are associated with increased utilization of services with more variable evidence of their impact on reducing early neonatal and maternal mortality. Further research is needed to understand how to maximize the potential of demand-side interventions to improve maternal and neonatal health outcomes including the role of quality improvement and coordination with supply-side interventions.

No MeSH data available.