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Appendix 4.3: Included items dealing with non-clinical interventions and maternal mortality Author (year) (IV)/(EV) Service organisation Training and audit Awan (1989) (+)/(-) Bhatt (1989) (-)/(-) Bugalho (1993) (-)/(-) Target population Brief intervention description Targeted outcome(s) Women in general Infants in general Comprehensive MCH programme in Lahore, Pakistan, with the provision of one MCH centre in each of 8 urban and 2 rural settings, with targeted staff supervision and peer review. Women in general Establishment of routine medical audit throughout obstetrics department and confidential review of maternal deaths. Women in general Neonates in general Routine daily and weekly perinatal audit. Information was documented visibly on a board on the wall in the delivery room in which staff associated with a perinatal death were indicated by name. Maternal mortality Infant mortality Maternal mortality Neonatal mortality Perinatal mortality Stillbirth Findings summary Appendix 4.3 Declines in both MMR and IMR in the intervention areas, with end-point rates for IMR lower in the intervention area than the national average. Medical audit introduced in 1965. Maternal mortality was found to have decreased by 1984. Perinatal mortality showed a significant but transient improvement during the observation period 1982- 1991. 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? 214
Author (year) (IV)/(EV) de Muylder (1989) (-)/(-) Dumont (2005) (++)/(++) Dumont (2006) (++)/(++) Target population Brief intervention description Targeted outcome(s) Women in general Introduction of guidelines for management of dystocia, foetal distress, breech birth and Caesarean history at a maternity ward in Gweru, Zimbabwe. Pregnant women with haemorrhagic and hypertensive complications Pregnant women admitted to hospital for childbirth Implementation of obstetric guidelines using volunteer professionals at an obstetric unit in Senegal. Facility-based maternal death reviews (MDRs) of a district maternity hospital in Senegal. Maternal mortality Perinatal mortality Case fatality for haemorrhage Case fatality for hypertension Case fatality for haemorrhage and hypertension Maternal mortality Findings summary Appendix 4.3 Comparison of the two-year periods before and after the intervention showed that the maternal mortality rate declined from 2.0 to 0.5%, and the perinatal mortality rate from 71.9 to 56.2%, alongside a decline in the Csection rate. Patients characteristic-adjusted case fatality decreased during the intervention period compared with the baseline periods. Outcome improvements were more marked for hypertension than haemorrhage. MDR helped to improve the organisation of care, with a marked effect on the availability of life-saving interventions. Data on clinical outcomes showed a significant decrease in maternal mortality within a 3-year intervention period, in particular for deaths related to haemorrhage and hypertensive disorders. 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? 215
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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
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Study Setting Intervention type Nah
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Study Setting Intervention type Pad
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Study Setting Intervention type Str
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Study Setting Intervention type Zia
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Appendix 3.2 Adam G K, Abdulla M A,
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Appendix 3.2 Balkus J, Bosire R, Jo
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Appendix 3.2 Boerma J T, Stroh G (1
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Appendix 3.2 Chiwuzie J, Okojie O,
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Appendix 3.2 De Alencar A E, Arraes
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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 and 200: Appendix 3.5 Appendix 3.5: Studies
Page 201 and 202: Orji (2003) (-)/(-) Shihadeh (2001)
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: Author (year) (IV)/(EV) Martins (20
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
Page 251: The authors of this report were sup
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