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2. International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries – case report series and suggested actions

Author

Okafor, Obiageli, Roos, Nathalie, Abdosh, Abdulfetah Abdulkadir, Adesina, Olubukola, Alaoui, Zaynab, Romero, William Arriaga, Assarag, Bouchra, Aworinde, Olufemi, de Bernis, Luc, Castro, Rigoberto, Chrifi, Hassan, Day, Louise Tina, Demissew, Rahel, Aceituno, María Guadalupe Flores, Gadama, Luis, Gashawbeza, Biruck, Keke, Sourou Goufodji, Govule, Philip, Gwako, George, Jayaratne, Kapila, Komboigo, Evelyne Béwendin, Lara, Bredy, Madziyire, Mugove Gerald, Mathai, Matthews, Moulki, Rachid, Moutaouadia, Iatimad, Munjanja, Stephen, Fletes, Carlos Alberto Ochoa, Ortiz, Edgar Ivan, Ouedraogo, Henri Gautier, Qureshi, Zahida, Recidoro, Zenaida Dy, Senanayake, Hemantha, Soma-Pillay, Priya, Tin, Khaing Nwe, Sedami, Pascal, Worku, Dawit, and Bonet, Mercedes

Published
2022
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5. Availability of facility resources and services and infection-related maternal outcomes in the WHO Global Maternal Sepsis Study: a cross-sectional study

Author

Brizuela, Vanessa, Cuesta, Cristina, Bartolelli, Gino, Abdosh, Abdulfetah Abdulkadir, Abou Malham, Sabina, Assarag, Bouchra, Castro, Rigoberto, Díaz, Virginia, El Kak, Faysal, Elsheikh, Mohamed, Pérez, Aquilino M., Souza, João Paulo, Bonet, Mercedes, Abalos, Edgardo, Aman, Mohammad Iqbal, Noormal, Bashir, Espinoza, Marisa, Pasquale, Julia, Leroy, Charlotte, Roelens, Kristien, Vandenberghe, Griet, Agossou, M. Christian Urlyss, Goufodji Keke, Sourou, Tshabu Aguemon, Christiane, Apaza Peralta, Patricia Soledad, Conde Altamirano, Víctor, Hernández Muñoz, Rosalinda, Cecatti, José Guilherme, Ribeiro do Valle, Carolina, Batiene, Vincent, Cisse, Kadari, Ouedraogo, Henri Gautier, Cheang, Kannitha, Lam, Phirun, Rathavy, Tung, Simo, Elie, Tebeu, Pierre-Marie, Yakana, Emah Irene, Carvajal, Javier, Escobar, María Fernanda, Fernández, Paula, Colmorn, Lotte Berdiin, Langhoff-Roos, Jens, Mereci, Wilson, Vélez, Paola, Salah Eldin, Yasser, Sultan, Alaa, Teklu, Alula M., Worku, Dawit, Adanu, Richard, Govule, Philip, Noora Lwanga, Charles, Arriaga Romero, William Enrique, Flores Aceituno, María Guadalupe, Bustillo, Carolina, Lara, Bredy, Kumar, Vijay, Suri, Vanita, Trikha, Sonia, Cetin, Irene, Donati, Serena, Personeni, Carlo, Baimussanova, Guldana, Kabylova, Saule, Sagyndykova, Balgyn, Gwako, George, Osoti, Alfred, Qureshi, Zahida, Asylbasheva, Raisa, Boobekova, Aigul, Seksenbaeva, Damira, Itani, Saad Eddine, Minkauskienė, Meilė, Ramašauskaitė, Diana, Chikhwaza, Owen, Gadama, Luis, Malunga, Eddie, Dembele, Haoua, Sangho, Hamadoun, Zerbo, Fanta Eliane, Dávila Serapio, Filiberto, Herrera Maldonado, Nazarea, Islas Castañeda, Juan I., Cauaus, Tatiana, Curteanu, Ala, Petrov, Victor, Buyanjargal, Yadamsuren, Khishgee, Seded, Lkhagvasuren, Bat-Erdene, Essolbi, Amina, Moulki, Rachid, Jaze, Zara, Mariano, Arlete, Bique Osman, Nafissa, Einda, Hla Mya Thway, Maung, Thae Maung, Tin, Khaing Nwe, Gurung, Tara, Shrestha, Amir Babu, Shrestha, Sangeeta, Bloemenkamp, Kitty, Rijken, Marcus J., Van Den Akker, Thomas, Estrada, María Esther, Pavón Gómez, Néstor J., Adesina, Olubukola, Aimakhu, Chris, Fawole, Bukola, Chaudhri, Rizwana, Hamid, Saima, Khan, M. Adnan, Huatuco Hernández, María del Pilar, Zavaleta Pimentel, Nelly M., Andal, Maria Lu, Recidoro, Zenaida Dy, Martin, Carolina Paula, Budianu, Mihaela, Puşcaşiu, Lucian, Diouf, Léopold, Guirassy, Dembo, Moreira, Philippe Marc, Borovsky, Miroslav, Kovac, Ladislav, Kristufkova, Alexandra, Cebekhulu, Sylvia, Cornelissen, Laura, Soma-Pillay, Priya, Cararach, Vicenç, López, Marta, Vidal Benedé, María José, Jayakody, Hemali, Jayaratne, Kapila, Rowel, Dhammica, Nabag, Wisal, Omer, Sara, Tsoy, Victoria, Uzakova, Urunbish, Yunusova, Dilrabo, Siriwachirachai, Thitiporn, Tangsiriwatthana, Thumwadee, Dunlop, Catherine, Knight, Marian, Lissauer, David, Roman, Jhon, Vitureira, Gerardo, Tuan, Dinh Anh, Truong, Luong Ngoc, Hanh, Nghiem Thi Xuan, Madziyire, Mugove, Magwali, Thulani, Munjanja, Stephen, Baguiya, Adama, Chamillard, Mónica, Kouanda, Seni, Lumbiganon, Pisake, Nabhan, Ashraf, Nadisauskiene, Ruta, Bartlett, Linda, Bellissimo-Rodrigues, Fernando, Jacob, Shevin T., Shakoor, Sadia, Yunis, Khalid, Campodónico, Liana, Gamerro, Hugo, Giordano, Daniel, Althabe, Fernando, Gülmezoglu, A. Metin, Castro Banegas, Rigoberto, El-Kak, Faysal, El Sheikh, Mohamed, and Pérez, Aquilino M

Published
2021
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6. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study

Author

Bonet, Mercedes, Brizuela, Vanessa, Abalos, Edgardo, Cuesta, Cristina, Baguiya, Adama, Chamillard, Mónica, Fawole, Bukola, Knight, Marian, Kouanda, Seni, Lumbiganon, Pisake, Nabhan, Ashraf, Nadisauskiene, Ruta J, Abdulkadir, Abdulfetah, Adanu, Richard MK, Aman, Mohammad Iqbal, Arriaga Romero, William E., Assarag, Bouchra, Bloemenkamp, Kitty W.M., Boobekova, Aigul, Budianu, Mihaela A., Cararach, Vicenç, Castro, Rigoberto, Cebekhulu, Sylvia, Cecatti, José Guilherme, Colmorn, Lotte Berdiin, Curteanu, Ala, Donati, Serena, Einda, Hla Mya Thway, El Deen, Yasser Salah, El Kak, Faysal, Elsheikh, Mohamed, Escobar-Vidarte, Maria F, Espinoza, Marisa Mabel, Estrada, María Ester, Gadama, Luis Aaron, Goufodji, Sourou B, Hamid, Saima, Hernandez Munoz, Rosalinda, Herrera Maldonado, Nazarea, Jayaratne, Kapila, Kabylova, Saule, Kristufkova, Alexandra, Kumar, Vijay, Lissauer, David, Mereci, Wilson, Minkauskiene, Meile, Moreira, Philippe, Munjanja, Stephen, B. Osman, Nafissa, Ouedraogo, Henri Gautier, Perez, Aquilino M., Pasquale, Julia, Puscasiu, Lucian, Qureshi, Zahida, Recidoro, Zenaida, C. Ribeiro-do-Valle, Carolina, Rowel, Dhammica, Sangho, Hamadoun, Shrestha, Amir Babu, Siriwachirachai, Thitiporn, Tebeu, Pierre Marie, Tin, Khaing Nwe, Tuan, Dinh Anh, Tung, Rathavy, Vandenberghe, Griet, Yadamsuren, Buyanjargal, Yunusova, Dilrabo, Zavaleta Pimentel, Nelly, Noormal, Bashir, Díaz, Virginia, Leroy, Charlotte, Roelens, Kristien, Agossou, M. Christian Urlyss, Tshabu Aguemon, Christiane, Apaza Peralta, Patricia Soledad, Conde Altamirano, Víctor, Batiene, Vincent, Cisse, Kadari, Cheang, Kannitha, Lam, Phirun, Simo, Elie, Yakana, Emah Irene, Carvajal, Javier, Fernández, Paula, Langhoff-Roos, Jens, Vélez, Paola, Sultan, Alaa, Teklu, Alula M., Worku, Dawit, Govule, Philip, Noora Lwanga, Charles, Flores Aceituno, María Guadalupe, Bustillo, Carolina, Lara, Bredy, Suri, Vanita, Trikha, Sonia, Cetin, Irene, Personeni, Carlo, Baimussanova, Guldana, Sagyndykova, Balgyn, Gwako, George, Osoti, Alfred, Asylbasheva, Raisa, Seksenbaeva, Damira, Itani, Saad Eddine, Abou Malham, Sabina, Ramašauskaitė, Diana, Chikhwaza, Owen, Malunga, Eddie, Dembele, Haoua, Zerbo, Fanta Eliane, Dávila Serapio, Filiberto, Islas Castañeda, Juan I., Cauaus, Tatiana, Petrov, Victor, Khishgee, Seded, Lkhagvasuren, Bat-Erdene, Essolbi, Amina, Moulki, Rachid, Jaze, Zara, Mariano, Arlete, Maung, Thae Maung, Gurung, Tara, Shrestha, Sangeeta, Rijken, Marcus J., Van Den Akker, Thomas, Estrada, María Esther, Pavón Gómez, Néstor J., Adesina, Olubukola, Aimakhu, Chris, Chaudhri, Rizwana, Khan, M. Adnan, Huatuco Hernández, María del Pilar, Andal, Maria Lu, Martin, Carolina Paula, Diouf, Léopold, Guirassy, Dembo, Borovsky, Miroslav, Kovac, Ladislav, Cornelissen, Laura, Soma-Pillay, Priya, López, Marta, Vidal Benedé, María José, Jayakody, Hemali, Nabag, Wisal, Omer, Sara, Tsoy, Victoria, Uzakova, Urunbish, Tangsiriwatthana, Thumwadee, Dunlop, Catherine, Roman, Jhon, Vitureira, Gerardo, Truong, Luong Ngoc, Hanh, Nghiem Thi Xuan, Madziyire, Mugove, Magwali, Thulani, Bartlett, Linda, Bellissimo-Rodrigues, Fernando, Jacob, Shevin T., Shakoor, Sadia, Yunis, Khalid, Campodónico, Liana, Gamerro, Hugo, Giordano, Daniel, Althabe, Fernando, Gülmezoglu, A. Metin, and Souza, João Paulo

Published
2020
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8. Evidence-based antenatal interventions to reduce the incidence of small vulnerable newborns and their associated poor outcomes

Author

Hofmeyr, G Justus, primary, Black, Robert E, additional, Rogozińska, Ewelina, additional, Heuer, Austin, additional, Walker, Neff, additional, Ashorn, Per, additional, Ashorn, Ulla, additional, Bhandari, Nita, additional, Bhutta, Zulfiqar A, additional, Koivu, Annariina, additional, Kumar, Somesh, additional, Lawn, Joy E, additional, Munjanja, Stephen, additional, Näsänen-Gilmore, Pieta, additional, Ramogola-Masire, Doreen, additional, Temmerman, Marleen, additional, Klein, Nigel, additional, Hofmeyr, G Justus, additional, and Askari, Sufia, additional

Published
2023
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9. Prepregnancy and Early Pregnancy Calcium Supplementation Among Women at High Risk of Pre-eclampsia: A Multicentre, Double-blind, Randomised, Placebo-Controlled Trial

Author

Hofmeyr, G. Justus, Betrán, Ana Pilar, Singata-Madliki, Mandisa, Cormick, Gabriela, Munjanja, Stephen P., Fawcus, Susan, Mose, Simpiwe, Hall, David, Ciganda, Alvaro, Seuc, Armando H., Lawrie, Theresa A., Bergel, Eduardo, Roberts, James M., von Dadelszen, Peter, and Belizán, José M.

Published
2019
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11. Maternal mortality decline in Zimbabwe, 2007/2008 to 2018/2019: findings from mortality surveys using civil registration, vital statistics and health system data

Author

Musarandega, Reuben, primary, Cresswell, Jenny, additional, Magwali, Thulani, additional, Makosa, Davidzoyashe, additional, Machekano, Rhoderick, additional, Ngwenya, Solwayo, additional, Nystrom, Lennarth, additional, Pattinson, Robert, additional, and Munjanja, Stephen, additional

Published
2022
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15. Additional file 1 of International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries – case report series and suggested actions

Author

Okafor, Obiageli, Roos, Nathalie, Abdosh, Abdulfetah Abdulkadir, Adesina, Olubukola, Alaoui, Zaynab, Romero, William Arriaga, Assarag, Bouchra, Aworinde, Olufemi, de Bernis, Luc, Castro, Rigoberto, Chrifi, Hassan, Day, Louise Tina, Demissew, Rahel, Aceituno, María Guadalupe Flores, Gadama, Luis, Gashawbeza, Biruck, Keke, Sourou Goufodji, Govule, Philip, Gwako, George, Jayaratne, Kapila, Komboigo, Evelyne Béwendin, Lara, Bredy, Madziyire, Mugove Gerald, Mathai, Matthews, Moulki, Rachid, Moutaouadia, Iatimad, Munjanja, Stephen, Fletes, Carlos Alberto Ochoa, Ortiz, Edgar Ivan, Ouedraogo, Henri Gautier, Qureshi, Zahida, Recidoro, Zenaida Dy, Senanayake, Hemantha, Soma-Pillay, Priya, Tin, Khaing Nwe, Sedami, Pascal, Worku, Dawit, and Bonet, Mercedes

Abstract

Additional file 1. Supplementary appendix to “International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries – Case report series and suggested actions. Study forms used for data collection and during the external review meetings. Results of a baseline assessment of maternal death review (MDR) committees and practices in participating GLOSS facilities. Additional information on the causes of deaths and distribution of modifiable factors described in this study.

Published
2022
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17. National policies and care provision in pregnancy and childbirth for twins in Eastern and Southern Africa: A mixed-methods multi-country study

Author

Hanson, Claudia, Munjanja, Stephen, Binagwaho, Agnes, Vwalika, Bellington, Pembe, Andrea B., Jacinto, Elsa, Chilinda, George K., Donahoe, Kateri B., Wanyonyi, Sikolia Z., Waiswa, Peter, Gidiri, Muchabayiwa F., and Benova, Lenka

Subjects
Delivery (Childbirth) -- Health aspects -- Research, Health policy -- Analysis, Practice guidelines (Medicine) -- Research, Maternal health services -- Research, Multiple pregnancy -- Health aspects, Pregnant women -- Health aspects, Mortality, Obstetrics, Cesarean section, Infant mortality, Pregnancy, Sustainable development, Health surveys, Newborn infants, Twins, Biological sciences
Abstract

Background High-risk pregnancies, such as twin pregnancies, deserve particular attention as mortality is very high in this group. With a view to inform policy and national guidelines development for the Sustainable Development Goals, we reviewed national training materials, guidelines, and policies underpinning the provision of care in relation to twin pregnancies and assessed care provided to twins in 8 Eastern and Southern African countries: Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Methods and findings We located policies and guidelines by reviewing national repositories and by contacting experts to systematically map country-level maternal and newborn training materials, guidelines, and policies. We extracted recommendations for care for twins spanning ante-, intra-, and postpartum care that typically should be offered during twin pregnancies and childbirth. We compared care provided for mothers of twins to that provided for mothers of singletons during the ante-, intra-, and postpartum period and computed neonatal mortality rates using the most recent Demographic and Health Surveys (DHS) data for each country. There was a paucity of guidance on care specifically for twin or multiple pregnancies: None of the countries provided clear guidance on additional number of antenatal care visits or specific antenatal content, while 7 of the 8 countries recommended twins to be delivered in a comprehensive emergency obstetric and neonatal care facility. These results were mirrored by DHS results of 73,462 live births (of which 1,360 were twin) indicating that twin pregnancies did not receive more frequent or intensified antenatal care. The percentage of twin deliveries in hospitals varied from 25.3% in Mozambique to 63.0% in Kenya, and women with twin deliveries were between 5 and 27 percentage points more likely to deliver in hospitals compared to women with singleton live births; this difference was significant in 5 of the 8 countries (t test p < 0.05). The percentage of twin deliveries by cesarean section varied from 9% in Mozambique to 36% in Rwanda. The newborn mortality rate among twins, adjusted for maternal age and parity, was 4.6 to 7.2 times higher for twins compared to singletons in all 8 countries. Conclusions Despite the limited sample size and the limited number of clinically relevant services evaluated, our study provided evidence that mothers of twins receive insufficient care and that mortality in twin newborns is very high in Eastern and Southern Africa. Most countries have insufficient guidelines for the care of twins. While our data do not allow us to make a causal link between insufficient guidelines and insufficient care, they call for an assessment and reconceptualisation of policies to reduce the unacceptably high mortality in twins in Eastern and Southern Africa., Author(s): Claudia Hanson 1,2,*, Stephen Munjanja 3, Agnes Binagwaho 4, Bellington Vwalika 5, Andrea B. Pembe 6, Elsa Jacinto 7, George K. Chilinda 8, Kateri B. Donahoe 4, Sikolia Z. [...]

Published
2019
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20. FIGO good practice recommendations on cervical cerclage for prevention of preterm birth

Author

Shennan, Andrew, Story, Lisa, Jacobsson, Bo, Grobman, William A., Simpson, Joe Leigh, Norman, Jane E., Bianchi, Ana, Munjanja, Stephen, González, Catalina María Valencia, and Mol, Ben W.

Subjects
Fetus, medicine.medical_specialty, business.industry, Vaginal delivery, Obstetrics, medicine.medical_treatment, Infant, Newborn, Obstetrics and Gynecology, General Medicine, Cervix Uteri, Short cervix, Pregnancy, Pregnancy Trimester, Second, medicine, Cervical os, Humans, Premature Birth, Cervical cerclage, Female, business, Good practice, Cervical length, Cerclage, Cervical
Abstract

Cervical cerclage is an intervention which when given to the right women can prevent preterm birth and second-trimester fetal losses. A history-indicated cerclage should be offered to women who have had three or more preterm deliveries and/or mid-trimester losses. An ultrasound-indicated cerclage should be offered to women with a cervical length

Published
2021

25. Where is maternal and child health now?

Author

Lawn, Joy E., Tinker, Anne, Munjanja, Stephen P., and Cousens, Simon

Subjects
Developing countries -- Health aspects, Maternal health services -- Forecasts and trends, Child health services -- Forecasts and trends, World health -- Aims and objectives, Mothers -- Patient outcomes, Mothers -- Causes of, Mothers -- Forecasts and trends, Mothers -- Prevention, Market trend/market analysis
Published
2006

28. Prepregnancy and early pregnancy calcium supplementation among women at high risk of pre-eclampsia: a multicentre, double-blind, randomised, placebo-controlled trial

Author

Hofmeyr, G Justus, primary, Betrán, Ana Pilar, additional, Singata-Madliki, Mandisa, additional, Cormick, Gabriela, additional, Munjanja, Stephen P, additional, Fawcus, Susan, additional, Mose, Simpiwe, additional, Hall, David, additional, Ciganda, Alvaro, additional, Seuc, Armando H, additional, Lawrie, Theresa A, additional, Bergel, Eduardo, additional, Roberts, James M, additional, von Dadelszen, Peter, additional, Belizán, José M, additional, Althabe, Fernando, additional, Sawchuck, Diane, additional, Vidler, Marianne, additional, Allie, Saadiqa, additional, Anthony, John, additional, Frank, Karlyn, additional, de Greeff, Annmarie, additional, Fawcus, Sue, additional, Hofmeyr, Justus, additional, Kovane, Mvuseleli, additional, Kovane, Patience, additional, Lawrie, Theresa, additional, Mshweshwe, Nolundi, additional, Mqikela, Velisa, additional, Njikelana, Pamela, additional, Novikova, Natalia, additional, Oyebajo, Adegboyega, additional, Parker, Catherine, additional, Phuti, Angel, additional, van Papendorp, Erika, additional, Williams, Xoliswa, additional, Dannemann, Tina, additional, Seuc, Armando, additional, Magee, Laura, additional, Donnay, France, additional, Drebit, Sharla, additional, Roberts, Jim, additional, Guzha, Bothwell, additional, Makaza, Emilia, additional, Manyame, Sarah, additional, Munjanja, Stephen, additional, and Tahuringana, Eunice, additional

Published
2019
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34. Protocol for analysing the epidemiology of maternal mortality in Zimbabwe: A civil registration and vital statistics trend study.

Author

Musarandega, Reuben, Machekano, Rhoderick, Pattinson, Robert, and Munjanja, Stephen Peter

Subjects
MATERNAL mortality, VITAL statistics, PROOF & certification of death, NOSOLOGY, CAUSES of death, DEATH certificates, RECORDING & registration
Abstract

Background: Sub-Saharan Africa (SSA) carries the highest burden of maternal mortality, yet, the accurate maternal mortality ratios (MMR) are uncertain in most SSA countries. Measuring maternal mortality is challenging in this region, where civil registration and vital statistics (CRVS) systems are weak or non-existent. We describe a protocol designed to explore the use of CRVS to monitor maternal mortality in Zimbabwe—an SSA country. Methods: In this study, we will collect deliveries and maternal death data from CRVS (government death registration records) and health facilities for 2007–2008 and 2018–2019 to compare MMRs and causes of death. We will code the causes of death using classifications in the maternal mortality version of the 10th revision to the international classification of diseases. We will compare the proportions of maternal deaths attributed to different causes between the two study periods. We will also analyse missingness and misclassification of maternal deaths in CRVS to assess the validity of their use to measure maternal mortality in Zimbabwe. Discussion: This study will determine changes in MMR and causes of maternal mortality in Zimbabwe over a decade. It will show whether HIV, which was at its peak in 2007–2008, remains a significant cause of maternal deaths in Zimbabwe. The study will recommend measures to improve the quality of CRVS data for future use to monitor maternal mortality in Zimbabwe and other SSA countries of similar characteristics. [ABSTRACT FROM AUTHOR]

Published
2021
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35. 2016 Zimbabwe: Independent Evaluation of the Health Transition Fund in Zimbabwe

Author

Nynke van den Broek, Thidar Pyone, Owolabi, Helen, Munjanja, Stephen, Caffrey, Margaret, Lijdsman, Michael, Sarah White, and Nygaard, Siv Steffen

Subjects
wa_30, 41b6e438, f0e481db, wa_540
Abstract

With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System (GEROS)". Within this system, an external independent company reviews and rates all evaluation reports. The quality rating scale for evaluation reports is as follows: “Highly Satisfactory”, “Satisfactory”, “Fair” or “Unsatisfactory”. You will find the link to the quality rating below, labelled as ‘Part 3’ of the report, and the executive feedback summary labelled as 'Part 4'.

Published
2016

41. Translating coverage gains into health gains for all women and children: the quality care opportunity

Author

Graham, Wendy J., McCaw-Binns, Affette, and Munjanja, Stephen

Subjects
Women -- Health aspects, Health care reform -- Management, Children -- Health aspects, Medical care -- Quality management -- Economic aspects -- United States, Company business management, Biological sciences
Abstract

The proportion of women and children receiving health care in the poorest countries is increasing [1]. Unfortunately, markers of improved health outcomes, such as falling maternal or newborn mortality, have [...]

Published
2013
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45. The effectiveness of emergency obstetric referral interventions in developing country settings: a systematic review

Author

Hussein, Julia, Kanguru, Lovney, Astin, Margaret, and Munjanja, Stephen

Subjects
Obstetrical nursing -- Analysis, Pregnancy, Complications of -- Research, Emergency medical services -- Analysis, Pregnant women -- Care and treatment, Biological sciences
Abstract

Background: Pregnancy complications can be unpredictable and many women in developing countries cannot access health facilities where life-saving care is available. This study assesses the effects of referral interventions that enable pregnant women to reach health facilities during an emergency, after the decision to seek care is made. Methods and findings: Selected bibliographic databases were searched with no date or language restrictions. Randomised controlled trials and quasi experimental study designs with a comparison group were included. Outcomes of interest included maternal and neonatal mortality and other intermediate measures such as service utilisation. Two reviewers independently selected, appraised, and extracted articles using predefined fields. Forest plots, tables, and qualitative summaries of study quality, size, and direction of effect were used for analysis. Nineteen studies were included. In South Asian settings, four studies of organisational interventions in communities that generated funds for transport reduced neonatal deaths, with the largest effect seen in India (odds ratio 0-48 95% CI 0-34-0-68). Three quasi experimental studies from sub-Saharan Africa reported reductions in stillbirths with maternity waiting home interventions, with one statistically significant result (OR 0.56 95% CI 0.32-0.96). Effects of interventions on maternal mortality were unclear. Referral interventions usually improved utilisation of health services but the opposite effect was also documented. The effects of multiple interventions in the studies could not be disentangled. Explanatory mechanisms through which the interventions worked could not be ascertained. Conclusions: Community mobilisation interventions may reduce neonatal mortality but the contribution of referral components cannot be ascertained. The reduction in stillbirth rates resulting from maternity waiting homes needs further study. Referral interventions can have unexpected adverse effects. To inform the implementation of effective referral interventions, improved monitoring and evaluation practices are necessary, along with studies that develop better understanding of how interventions work. Please see later in the article for the Editors' Summary., Introduction The importance of referral in an obstetric emergency is related to the unpredictability of pregnancy complications and their potential to progress rapidly to become severe and life threatening. For [...]

Published
2012
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