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Appendix 4.1: Included items dealing with clinical interventions and maternal mortality Author (year) (IV)/(EV) Target population Brief intervention description Targeted outcome(s) Surgical/instrumental procedures Agarwal (2007a) (+)/(++) Malhotra (1994) (+)/(-) Women with post- Caesarean pregnancy Women with preterm breech delivery Comparison of CS and vaginal birth after Caesarean (VBAC). CS: The general policy of this hospital does not favour routine use of CS for a preterm breech foetus. Before 33 completed weeks of gestation, CS is occasionally performed for foetal indication unless associated with adverse obstetric factors. The indications for CS for a preterm breech after 33 weeks are the same as for a singleton term breech foetus. All the CS and a majority of the vaginal deliveries were attended by a paediatrician who assessed the newborn for gestational age, congenital abnormality and birth injury, and assigned the Apgar score. Neonatal mortality Perinatal mortality Stillbirth Combined intrapartum and neonatal deaths Findings summary Appendix 4.1 VBAC is associated with higher perinatal mortality and maternal morbidity. Although the combined intrapartum and neonatal mortality was significantly higher for vaginal delivery (35.9% vs 17.7%), there was no significant difference when the data was correlated with birthweight or gestational age. What are the effects of different models of delivery for improving maternal and infant health outcomes for poor people in urban areas in low income and lower middle income countries? 194
Orji (2003) (-)/(-) Shihadeh (2001) (-)/(+) Ziadeh (1997) (-)/(-) Singleton mothers with breech delivery Mothers with instrumental deliveries Women with preterm breech presentation Planned vaginal delivery vs planned CS delivery for breech delivery. Retrospective comparison of forceps and vacuum extraction delivery. Abdominal vs vaginal delivery for singleton preterm breech. Perinatal mortality Perinatal mortality Early neonatal mortality Stillbirth Appendix 4.1 Claims that the outcomes for planned vaginal deliveries may be no worse than planned Caesarean sections, given appropriate selection criteria and management. There was no difference in perinatal mortality. Low Apgar scores were more common on vaginal delivery group but traumatic morbidity was not. Maternal morbidity was higher in Caesarean section group. Maternal birth canal and genital tract lacerations were significantly more common in forceps delivery. There was increased infant morbidity and mortality from vacuum extraction deliveries but overall vacuum extraction was recommended. There was no significant difference in intrapartum death and early neonatal mortality between those who delivered vaginally and those who delivered by Caesarean section (16.6 vs 15.6%). So even with optimum neonatal care facilities, Caesarean section does not offer any advantage over vaginal delivery in a developing country. What are the effects of different models of delivery for improving maternal and infant health outcomes for poor people in urban areas in low income and lower middle income countries? 195
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Systematic review What are the effe
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Contents List of abbreviations ....
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List of abbreviations AIDS Acquired
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Executive summary Background Execut
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Executive summary be to retrospecti
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Background many LICs and LMCs, it i
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Background Cross-sectional surveys
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Background For some causes of mater
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Background informal settlements on
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Background review focused on explic
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Types of intervention Interventions
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Box 2.2: Websites searched AFD (Age
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second stage previously described f
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using qualitative analysis to attem
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Figure 3.1: Filtering of papers fro
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Middle East and North Africa (8%) S
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Search results access or satisfacti
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4. Synthesis results Summary Synthe
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Synthesis results Four studies focu
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Drug treatments (including micronut
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Synthesis results Training and audi
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Synthesis results order to be effec
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Synthesis results government admini
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HIV/AIDS and Malaria, as well as no
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Synthesis results ASSESSING THE COS
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and birthing care services, includi
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Synthesis results of settings were
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Figure 4.1: Causal chain for matern
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4.3 Summary of results of causal ch
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5. Strengths and limitations Summar
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6. Conclusions and recommendations
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Conclusions and recommendations Urb
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References Bakr A F, Karkour T (200
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References Deschamps M M, Noel F, B
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References Lim S, Dandona L, Hoisin
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References Shantharam Baliga B, Rag
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References Channon A A, Falkingham
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References Jowett M (2000) Safe Mot
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References Rice J, Rice J S (2009)
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Appendices Appendix 1.1: Authorship
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Appendix 2.1: Inclusion and exclusi
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Appendix 2.2: Search strategy for e
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Appendix 2.2 Infant* OR Matern* OR
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OR/ 12-13 11 AND 14 Limit 15 to pub
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Appendix 2.4: Journals handsearched
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POOR PROFILE Is the study populatio
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infants (
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Appendix 2.5 Intervention (surgical
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Appendix 2.5 Intervention (service
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MORTALITY OUTCOME TYPES Which morta
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positive neutral negative unclear/n
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yes no unclear/not stated N/A Study
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surveillance system none of the abo
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no SELECTION CHARACTERISTICS Is inf
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Appendix 2.5 QUANTITATIVE DATA ADJU
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RESEARCHER RELATIONSHIP Has the rel
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Were the inclusion/exclusion criter
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person-years). 3.5 Was follow-up ti
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Appendix 2.7 Appendix 2.7: Quality
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triangulation, or for not triangula
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Was the study approved by an ethics
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Item Yes No Not clear 3. The viewpo
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Appendix 2.9: Electronic databases
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Web of Knowledge (including ISI Cit
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Study Setting Intervention type Abo
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Study Setting Intervention type Alw
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Study Setting Intervention type Ben
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Study Setting Intervention type Ble
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Study Setting Intervention type Cob
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Study Setting Intervention type Des
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Study Setting Intervention type Faw
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Study Setting Intervention type Jak
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Study Setting Intervention type Kup
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Study Setting Intervention type Mar
Page 149 and 150: Study Setting Intervention type Nah
Page 151 and 152: Study Setting Intervention type Pad
Page 153 and 154: Study Setting Intervention type Str
Page 155 and 156: Study Setting Intervention type Zia
Page 157 and 158: Appendix 3.2 Adam G K, Abdulla M A,
Page 159 and 160: Appendix 3.2 Balkus J, Bosire R, Jo
Page 161 and 162: Appendix 3.2 Boerma J T, Stroh G (1
Page 163 and 164: Appendix 3.2 Chiwuzie J, Okojie O,
Page 165 and 166: Appendix 3.2 De Alencar A E, Arraes
Page 167 and 168: Appendix 3.2 Ekman B, Pathmanathan
Page 169 and 170: Appendix 3.2 Garg R, Omwomo W, Witt
Page 171 and 172: Appendix 3.2 Gupta R, Sachdev H P,
Page 173 and 174: Appendix 3.2 Hutton G, Schellenberg
Page 175 and 176: Appendix 3.2 Khandker S R, Latif M
Page 177 and 178: Appendix 3.2 Lindblade K A, Eisele
Page 179 and 180: Appendix 3.2 Menéndez C, Bardají
Page 181 and 182: Appendix 3.2 Nduati R, John G, Mbor
Page 183 and 184: Appendix 3.2 O'Rourke K (1995a) The
Page 185 and 186: Appendix 3.2 Prual A, De Bernis L,
Page 187 and 188: Appendix 3.2 Sabitu K, Alti-Mu'azu
Page 189 and 190: Appendix 3.2 Smith J B, Coleman N A
Page 191 and 192: Appendix 3.2 Van Rheenen P, De Moor
Page 193 and 194: Appendix 3.2 Xiang X, Wang L, Xu L
Page 195 and 196: Appendix 3.4 Appendix 3.4: Studies
Page 197 and 198: Appendix 3.4 International Bank for
Page 199: Appendix 3.5 Appendix 3.5: Studies
Page 203 and 204: Chinayon (1998) (+)/(+) Kamilya (20
Page 205 and 206: Nahar (2004) (-)/(-) Tukur (2007) (
Page 207 and 208: Ndibazza (2010) (++)/(+) Antiretrov
Page 209 and 210: Bergstrom (1991) (+)/(+) Women with
Page 211 and 212: Enakpene (2010) (+)/(-) Etuk (2000a
Page 213 and 214: Pereira (1996) (-)/(-) Saleem (2007
Page 215 and 216: Author (year) (IV)/(EV) Joshi (2007
Page 217 and 218: Author (year) (IV)/(EV) Aaby (2005)
Page 219 and 220: Author (year) (IV)/(EV) Martins (20
Page 221 and 222: Author (year) (IV)/(EV) de Muylder
Page 223 and 224: Author (year) (IV)/(EV) Provider mo
Page 225 and 226: Appendix 4.4: Included items dealin
Page 227 and 228: Author (year) (IV)/(EV) Target Popu
Page 229 and 230: Author (year) (IV)/(EV) Colonna (19
Page 231 and 232: Author (year) (IV)/(EV) Kuhn (2008)
Page 233 and 234: Author (year) (IV)/(EV) Target popu
Page 235 and 236: Author (year) (IV)/(EV) Mswia (2003
Page 237 and 238: Appendix 4.6: Included items dealin
Page 239 and 240: Appendix 4.8 Appendix 4.8: Economic
Page 241 and 242: Author (year) (IV)/(EV) and setting
Page 243 and 244: Appendix 4.9: Included items identi
Page 245 and 246: Author (year) (IV)/(EV) Poor urban
Page 247 and 248: Author (year) (IV)/(EV) Poor urban
Page 249 and 250: Appendix 4.10: High-quality include
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The authors of this report were sup
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