A systematic review of essential obstetric and newborn care capacity building in rural sub-Saharan Africa
GM Ni Bhuinneain
Department of Obstetrics and Gynaecology, Mayo Medical Academy, National University of Ireland Galway at Mayo General Hospital, Castlebar, Ireland
Friends of Londiani, Londiani, Kenya
Search for more papers by this authorCorresponding Author
FP McCarthy
Women's Health Academic Centre, King's Health Partners, St Thomas’ Hospital, London, UK
Department of Obstetrics and Gynaecology, Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland
Correspondence: Dr F McCarthy, Department of Obstetrics and Gynaecology, Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland. Email [email protected]Search for more papers by this authorGM Ni Bhuinneain
Department of Obstetrics and Gynaecology, Mayo Medical Academy, National University of Ireland Galway at Mayo General Hospital, Castlebar, Ireland
Friends of Londiani, Londiani, Kenya
Search for more papers by this authorCorresponding Author
FP McCarthy
Women's Health Academic Centre, King's Health Partners, St Thomas’ Hospital, London, UK
Department of Obstetrics and Gynaecology, Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland
Correspondence: Dr F McCarthy, Department of Obstetrics and Gynaecology, Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland. Email [email protected]Search for more papers by this authorAbstract
Background
Progress in maternal survival in sub-Saharan Africa has been poor since the Millennium Declaration.
Objectives
This systematic review aims to investigate the presence and rigour of evidence for effective capacity building for Essential Obstetric and Newborn Care (EONC) to reduce maternal mortality in rural, sub-Saharan Africa, where maternal mortality ratios are highest globally.
Search strategy
MEDLINE (1990–January 2014), EMBASE (1990–January 2014), and the Cochrane Library were included in our search. Key developing world issues of The Lancet and the British Journal of Obstetrics and Gynaecology, African Ministry of Health websites, and the WHO reproductive health library were searched by hand.
Selection criteria
Studies investigating essential obstetric and newborn care packages in basic and comprehensive care facilities, at community and institutional level, in rural sub-Saharan Africa were included. Studies were included if they reported on healthcare worker performance, access to care, community behavioural change, and emergency obstetric and newborn care.
Data collection and analysis
Data were extracted and all relevant studies independently appraised using structured abstraction and appraisal tools.
Main results
There is moderate evidence to support the training of healthcare workers of differing cadres in the provision of emergency obstetric and newborn services to reduce institutional maternal mortality and case-fatality rates in rural sub-Saharan Africa. Community schemes that sensitise and enable access to maternal health services result in a modest rise in facility birth and skilled birth attendance in this rural setting.
Authors' conclusion
Essential Obstetric and Newborn Care has merit as an intervention package to reduce maternal mortality in rural sub-Saharan Africa.
Supporting Information
| Filename | Description |
|---|---|
| bjo13218-sup-0001-TableS1-S7.pdfapplication/PDF, 187.7 KB | Table S1. PubMed search history. Table S2. Search question development. Table S3. Ranked search terms. Table S4. Number of articles recovered following search. Table S5. Scoping search: further development of search build in PubMed. Table S6. Search results in other databases. Table S7. Characteristics and quality assessment of studies included. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- 1Wilmoth JR, Mizoguchi N, Oestergaard MZ, Say L, Mathers CD, Zureick-Brown S, et al. A New method for deriving global estimates of maternal mortality. Stat Politics Policy 2012; 3: pii: 2151–7509.1038.
- 2Hill K, Thomas K, AbouZahr C, Walker N, Say L, Inoue M, et al. Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data. Lancet 2007; 370: 1311–9.
- 3 World Health Organisation U, UNFPA and the World Bank. Trends in Maternal Mortality 1990–2010. Estimates Developed by WHO, UNICEF, UNFPA and the World Bank. Geneva: World Health Organisation, 2012.
- 4Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 2005; 365: 977–88.
- 5Kehoe S, Neilson JP, Norman JE. Maternal and Infant Deaths: Chasing Millennium Development Goals 4 and 5. London: RCOG Press; 2010. pp. xiii, 334.
10.1017/CBO9781107784758.003 Google Scholar
- 6Houweling TA, Ronsmans C, Campbell OM, Kunst AE. Huge poor-rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries. Bull World Health Organ 2007; 85: 745–54.
- 7Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet 2006; 368: 1284–99.
- 8Kongnyuy EJ, Hofman JJ, van den Broek N. Ensuring effective Essential Obstetric Care in resource poor settings. BJOG 2009; 116 (Suppl 1): 41–7.
- 9Goodburn E, Campbell O. Reducing maternal mortality in the developing world: sector-wide approaches may be the key. BMJ 2001; 322: 917–20.
- 10Fotso JC, Ezeh A, Madise N, Ziraba A, Ogollah R. What does access to maternal care mean among the urban poor? Factors associated with use of appropriate maternal health services in the slum settlements of Nairobi, Kenya. Matern Child Health J 2009; 13: 130–7.
- 11Filippi V, Ronsmans C, Campbell OM, Graham WJ, Mills A, Borghi J, et al. Maternal health in poor countries: the broader context and a call for action. Lancet 2006; 368: 1535–41.
- 12Islam M, Yoshida S. Women are still deprived of access to lifesaving essential and emergency obstetric care. Int J Gynaecol Obstet 2009; 106: 120–4.
- 13Edwards C, Saha S. From home to hospital, a continuum of care: making progress towards Millennium Development Goals 4 and 5 in rural Bangladesh. BJOG 2011; 118 (Suppl 2): 88–92.
- 14Schiffman J, Darmstadt GL, Agarwal S, Baqui AH. Community-based intervention packages for improving perinatal health in developing countries: a review of the evidence. Semin Perinatol 2010; 34: 462–76.
- 15Nyamtema AS, Urassa DP, van Roosmalen J. Maternal health interventions in resource limited countries: a systematic review of packages, impacts and factors for change. BMC Pregnancy Childbirth 2011; 11: 30.
- 16Haws RA, Thomas AL, Bhutta ZA, Darmstadt GL. Impact of packaged interventions on neonatal health: a review of the evidence. Health Policy Plan 2007; 22: 193–215.
- 17Hussein J, Kanguru L, Astin M, Munjanja S. The effectiveness of emergency obstetric referral interventions in developing country settings: a systematic review. PLoS Med 2012; 9: e1001264.
- 18Gabrysch S, Campbell OM. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 2009; 9: 34.
- 19Higgins J, Green SP. Cochrane Handbook for Systematic Reviews of Interventions. Oxford: Wiley-Blackwell; 2008. pp. xxi, 649.
- 20Hofmeyr GJ, Say L, Gulmezoglu AM. WHO systematic review of maternal mortality and morbidity: the prevalence of uterine rupture. BJOG 2005; 112: 1221–8.
- 21Dahlgren G, Whitehead M. A framework for assessing health systems from the public's perspective: the ALPS approach. Int J Health Serv 2007; 37: 363–78.
- 22Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1994; 38: 1091–110.
- 23Akers J, Aguiar-Ibáñez R, Baba-Akbari Sari A, Beynon S, Booth A. Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care. York, UK: NHS Centre for Reviews and Dissemination, University of York, 2009.
- 24Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097.
- 25 AFRO WHO. Atlas of African Health Statistics 2014 – health situation analysis of the African region. [www.aho.afro.who.int/profiles_information/?lang=en]. Accessed 19 November 2014.
- 26 The Critical Skills Appraisal Programme: making sense of the evidence England: Public Health Resource Unit. 2006 [www.casp-uk.net/]. Accessed November 2014.
- 27Zaza S, Wright-De Aguero LK, Briss PA, Truman BI, Hopkins DP, Hennessy MH, et al. Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services. Task Force on Community Preventive Services. Am J Prev Med 2000; 18 (1 Suppl): 44–74.
- 28Thorne S, Jensen L, Kearney MH, Noblit G, Sandelowski M. Qualitative metasynthesis: reflections on methodological orientation and ideological agenda. Qual Health Res 2004; 14: 1342–65.
- 29Atkins D, Eccles M, Flottorp S, Guyatt GH, Henry D, Hill S, et al. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches the GRADE Working Group. BMC Health Serv Res 2004; 4: 38.
- 30Grady K, Ameh C, Adegoke A, Kongnyuy E, Dornan J, Falconer T, et al. Improving essential obstetric and newborn care in resource-poor countries. J Obstet Gynaecol 2011; 31: 18–23.
- 31Kirkpatrick DLKJ. Evaluating Training Programs – The Four Levels, 3rd edn. San Francisco: Berrett-Koehler Inc., 2006.
- 32Hounton SH, Newlands D, Meda N, De Brouwere V. A cost-effectiveness study of caesarean-section deliveries by clinical officers, general practitioners and obstetricians in Burkina Faso. Hum Resour Health 2009; 7: 34.
- 33Nyamtema AS, Pemba SK, Mbaruku G, Rutasha FD, van Roosmalen J. Tanzanian lessons in using non-physician clinicians to scale up comprehensive emergency obstetric care in remote and rural areas. Hum Resour Health 2011; 9: 28.
- 34Meher S, Alfirevic Z. Choice of primary outcomes in randomised trials and systematic reviews evaluating interventions for preterm birth prevention: a systematic review. BJOG 2014; 121: 1188–96.
- 35Gargon E, Williamson PR, Altman DG, Blazeby JM, Clarke M. The COMET Initiative database: progress and activities from 2011 to 2013. Trials 2014; 15: 279.
- 36 World Health Organisation. Optimizing Health Worker Roles to Improve Access to Key Maternal and Newborn Health Interventions Through Task Shifting; OPTIMIZEMNH. 2012. [http://www.optimizemnh.org/]. Accessed 19 November 2014.
- 37van den Akker T, van Rhenen J, Mwagomba B, Lommerse K, Vinkhumbo S, van Roosmalen J. Reduction of severe acute maternal morbidity and maternal mortality in Thyolo District, Malawi: the impact of obstetric audit. PLoS One 2011; 6: e20776.
- 38Bakker W, van den Akker T, Mwagomba B, Khukulu R, van Elteren M, van Roosmalen J. Health workers’ perceptions of obstetric critical incident audit in Thyolo District, Malawi. Tropical Med Int Health 2011; 16: 1243–50.
- 39Bhandari GP, Subedi N, Thapa J, Choulagai B, Maskey MK, Onta SR. A cluster randomized implementation trial to measure the effectiveness of an intervention package aiming to increase the utilization of skilled birth attendants by women for childbirth: study protocol. BMC Pregnancy Childbirth 2014; 14: 109.
- 40Dumont A, Fournier P, Abrahamowicz M, Traore M, Haddad S, Fraser WD. Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial. Lancet 2013; 382: 146–57.
- 41Kruk ME, Mbaruku G, McCord CW, Moran M, Rockers PC, Galea S. Bypassing primary care facilities for childbirth: a population-based study in rural Tanzania. Health Policy Plan 2009; 24: 279–88.
- 42Kruk ME, Rockers PC, Mbaruku G, Paczkowski MM, Galea S. Community and health system factors associated with facility delivery in rural Tanzania: a multilevel analysis. Health Policy 2010; 97: 209–16.
- 43Mpembeni RNM, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D, et al. Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets. BMC Pregnancy Childbirth 2007; 7: 29.
- 44Olsen OE, Ndeki S, Norheim OF. Human resources for emergency obstetric care in northern Tanzania: distribution of quantity or quality? Hum Resour Health 2005; 3: 5.
- 45Cham M, Sundby J, Vangen S. Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care. Reprod Health 2005; 2: 3.
- 46Tayler-Smith K, Zachariah R, Manzi M, Van den Boogaard W, Nyandwi G, Reid T, et al. Achieving the millennium development goal of reducing maternal mortality in rural Africa: an experience from Burundi. Trop Med Int Health 2013; 18: 166–74.
- 47Silal SP, Penn-Kekana L, Harris B, Birch S, McIntyre D. Exploring inequalities in access to and use of maternal health services in South Africa. BMC Health Serv Res 2012; 12: 120.
- 48Tlebere P, Jackson D, Loveday M, Matizirofa L, Mbombo N, Doherty T, et al. Community-based situation analysis of maternal and neonatal care in South Africa to explore factors that impact utilization of maternal health services. J Midwifery Womens Health 2007; 52: 342–50.
- 49Hailu M, Gebremariam A, Alemseged F, Deribe K. Birth preparedness and complication readiness among pregnant women in Southern Ethiopia. PLoS One 2011; 6: e21432.
- 50Moran AC, Sangli G, Dineen R, Rawlins B, Yameogo M, Baya B. Birth-preparedness for maternal health: findings from Koupela District, Burkina Faso. J Health Popul Nutr 2006; 24: 489–97.
- 51Rosato M, Mwansambo CW, Kazembe PN, Phiri T, Soko QS, Lewycka S, et al. Women's groups’ perceptions of maternal health issues in rural Malawi. Lancet 2006; 368: 1180–8.
- 52Colbourn T, Nambiar B, Bondo A, Makwenda C, Tsetekani E, Makonda-Ridley A, et al. Effects of quality improvement in health facilities and community mobilization through women's groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial. Int Health 2013; 5: 180–95.
- 53Lewycka S, Mwansambo C, Rosato M, Kazembe P, Phiri T, Mganga A, et al. Effect of women's groups and volunteer peer counselling on rates of mortality, morbidity, and health behaviours in mothers and children in rural Malawi (MaiMwana): a factorial, cluster-randomised controlled trial. Lancet 2013; 381: 1721–35.
- 54Spangler SA, Bloom SS. Use of biomedical obstetric care in rural Tanzania: the role of social and material inequalities. Soc Sci Med 2010; 71: 760–8.
- 55Hounton S, Menten J, Ouedraogo M, Dubourg D, Meda N, Ronsmans C, et al. Effects of a Skilled Care Initiative on pregnancy-related mortality in rural Burkina Faso. Tropical Med Int Health 2008; 13 (Suppl 1): 53–60.
- 56Kayongo M, Rubardt M, Butera J, Abdullah M, Mboninyibuka D, Madili M. Making EmOC a reality – CARE's experiences in areas of high maternal mortality in Africa. International Journal of Gynecology and Obstetrics 2006; 92: 308–19.
- 57Tayler-Smith K, Zachariah R, Manzi M, Van den Boogaard W, Nyandwi G, Reid T, et al. An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality. Tropical Med Int Health 2013; 18: 993–1001.
- 58Fournier P, Dumont A, Tourigny C, Dunkley G, Drame S. Improved access to comprehensive emergency obstetric care and its effect on institutional maternal mortality in rural Mali. Bull World Health Organ 2009; 87: 30–8.
