Abstract
BackgroundMany interventions have been implemented to improve maternal health outcomes in sub-Saharan Africa (SSA). Currently, however, systematic information on the effectiveness of these interventions remains scarce. We conducted a systematic review of published evidence on non-drug interventions that reported effectiveness in improving outcomes and quality of care in maternal health in SSA.MethodsAfrican Journals Online, Bioline, MEDLINE, Ovid, Science Direct, and Scopus databases were searched for studies published in English between 2000 and 2015 and reporting on the effectiveness of interventions to improve quality and outcomes of maternal health care in SSA. Articles focusing on interventions that involved drug treatments, medications, or therapies were excluded. We present a narrative synthesis of the reported impact of these interventions on maternal morbidity and mortality outcomes as well as on other dimensions of the quality of maternal health care (as defined by the Institute of Medicine 2001 to comprise safety, effectiveness, efficiency, timeliness, patient centeredness, and equitability).ResultsSeventy-three studies were included in this review. Non-drug interventions that directly or indirectly improved quality of maternal health and morbidity and mortality outcomes in SSA assumed a variety of forms including mobile and electronic health, financial incentives on the demand and supply side, facility-based clinical audits and maternal death reviews, health systems strengthening interventions, community mobilization and/or peer-based programs, home-based visits, counseling and health educational and promotional programs conducted by health care providers, transportation and/or communication and referrals for emergency obstetric care, prevention of mother-to-child transmission of HIV, and task shifting interventions. There was a preponderance of single facility and community-based studies whose effectiveness was difficult to assess.ConclusionsMany non-drug interventions have been implemented to improve maternal health care in SSA. These interventions have largely been health facility and/or community based. While the evidence on the effectiveness of interventions to improve maternal health is varied, study findings underscore the importance of implementing comprehensive interventions that strengthen different components of the health care systems, both in the community and at the health facilities, coupled with a supportive policy environment.Systematic review registrationPROSPERO CRD42015023750Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0305-6) contains supplementary material, which is available to authorized users.
Highlights
Many interventions have been implemented to improve maternal health outcomes in sub-Saharan Africa (SSA)
These interventions take a variety of forms, including general health system strengthening through activities like training of health care providers on key skills such as emergency obstetric care (EmOC), prevention of motherto-child transmission (PMTCT) of HIV, task shifting among health care workers, demand- and supply-side financial incentives, and mobile and electronic health interventions, among others
The interventions were broadly classified into mobile and electronic health interventions (n = 5; 7 %); financial incentives in the form of user fee exemptions and payments to health facilities based on performance (n = 13; 18 %); clinical audits (n = 13; 18 %); health systems and infrastructure development (n = 23; 32 %); community mobilization and peer-based programs (n = 8; 11 %); home visits and counseling and educational and health promotion programs (n = 5; 7 %); emergency transportation, communication, and referrals (n = 4; 6 %); PMTCT (n = 4; 6 %); and task shifting interventions (n = 2; 3 %)
Summary
Many interventions have been implemented to improve maternal health outcomes in sub-Saharan Africa (SSA). We conducted a systematic review of published evidence on non-drug interventions that reported effectiveness in improving outcomes and quality of care in maternal health in SSA. The maternal health crisis facing the region has led to a proliferation of interventions to improve the quality of maternal health services and health outcomes [7,8,9,10,11]. These interventions take a variety of forms, including general health system strengthening through activities like training of health care providers on key skills such as emergency obstetric care (EmOC), prevention of motherto-child transmission (PMTCT) of HIV, task shifting among health care workers, demand- and supply-side financial incentives, and mobile and electronic health interventions, among others. While evidence on the effectiveness of health interventions can support improvements in service delivery and promote population wellbeing [7, 10, 12, 13], there is a lack of critical and systematic analyses of the effectiveness of existing interventions that have been implemented in SSA to improve outcomes and quality of maternal health care
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