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(Philips et al., 2004) was available to assess the quality of economic evaluations based on a synthesis of effectiveness data from a range of papers and the construction of different forms of economic evaluation (Appendix 2.8). 2.3.2 Overall approach to and process of synthesis The approach to synthesis was driven by the research question, the types and quality of studies and the data included in the review. Heterogeneity of study design, population and intervention precluded statistical meta-analysis. The most appropriate approach – a textual narrative synthesis – was conducted. Because our review question involves two linked but distinct populations – mothers and infants – we have structured our review accordingly. For a subset of high-quality items, we conducted a causal chain analysis, also separated according to whether the outcome was maternal or infant mortality. 2.3.3 Selection of studies for synthesis The narrative synthesis includes all eligible studies on the basis of the inclusion/exclusion criteria. The causal change analyses are restricted to studies identified as high quality. 2.3.4 Selection of outcome data for synthesis Outcomes included maternal and infant health outcomes: maternal, infant, neonatal, perinatal, post-neonatal mortality, and still-birth; and severe acute maternal morbidity (SAMM) (haemorrhage, dystocia, hypertension, sepsis, incomplete abortion, Caesarean section (CS), hysterectomy and blood transfusion) (World Health Organization, 2011b). This review focuses on maternal and infant mortality outcomes. Process indicators, such as skilled care at birth, are often used as substitutes for mortality outcomes whose measurement poses considerable challenges. However, mortality outcomes are not necessarily improved where gains in individual process indicators are not accompanied by broader changes (Koblinsky et al., 1999). A focus on mortality outcomes is thus crucial, particularly in areas where the mortality burden is high (Campbell and Graham, 2006; Bhutta et al., 2008; Lawn et al., 2009). 2.3.5 Synthesis of evidence All eligible studies were included within the qualitative analysis to establish a detailed picture of the available evidence. We first analysed the data using EPPI- Reviewer 4 and generated comprehensive tables for each code. All tables were then exported and merged in Excel 13 to produce a unique results table. Narrative synthesis was the principal approach used. Eligible studies were grouped into type of interventions – broadly grouped into clinical and non-clinical – as described later on in the report. Findings were analysed within each category for the two main target populations: mothers and infants, including neonates. While most systematic reviews focus on synthesising evidence on effectiveness from quantitative research, we wanted to develop the contribution that can be made by different types of evidence, including that involving qualitative data. In addition, causal chain analysis was performed on included studies identified as high quality to allow the extraction and illustration of the casual path emerging from our review, linking reasoning for intervention, with experience, implementation and sustainability. We used an approach based on White’s (2009) theory-based impact evaluation, and drawing on the realist review approach of Pawson et al. (2005), 13 http://office.microsoft.com/en-us/excel/ Methods 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? 20
using qualitative analysis to attempt to provide an analysis of how and why complex interventions can work (Lewin et al., 2009). For each item included in the causal chain analysis, we identify the root causes of the issue, the intervention, the final outcome(s) and the intervention sustainability. 2.4 Deriving conclusions and implications Decisions about what the results meant for policy, practice and research were based on discussions within the review team, set against the wider knowledge base. Methods 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? 21
Page 1 and 2: Systematic review What are the effe
Page 3 and 4: Contents List of abbreviations ....
Page 5 and 6: List of abbreviations AIDS Acquired
Page 7 and 8: Executive summary Background Execut
Page 9 and 10: Executive summary be to retrospecti
Page 11 and 12: Background many LICs and LMCs, it i
Page 13 and 14: Background Cross-sectional surveys
Page 15 and 16: Background For some causes of mater
Page 17 and 18: Background informal settlements on
Page 19 and 20: Background review focused on explic
Page 21 and 22: Types of intervention Interventions
Page 23 and 24: Box 2.2: Websites searched AFD (Age
Page 25: second stage previously described f
Page 29 and 30: Figure 3.1: Filtering of papers fro
Page 31 and 32: Middle East and North Africa (8%) S
Page 33 and 34: Search results access or satisfacti
Page 35 and 36: 4. Synthesis results Summary Synthe
Page 37 and 38: Synthesis results Four studies focu
Page 39 and 40: Drug treatments (including micronut
Page 41 and 42: Synthesis results Training and audi
Page 43 and 44: Synthesis results order to be effec
Page 45 and 46: Synthesis results government admini
Page 47 and 48: HIV/AIDS and Malaria, as well as no
Page 49 and 50: Synthesis results ASSESSING THE COS
Page 51 and 52: and birthing care services, includi
Page 53 and 54: Synthesis results of settings were
Page 55 and 56: Figure 4.1: Causal chain for matern
Page 57 and 58: 4.3 Summary of results of causal ch
Page 59 and 60: 5. Strengths and limitations Summar
Page 61 and 62: 6. Conclusions and recommendations
Page 63 and 64: Conclusions and recommendations Urb
Page 65 and 66: References Bakr A F, Karkour T (200
Page 67 and 68: References Deschamps M M, Noel F, B
Page 69 and 70: References Lim S, Dandona L, Hoisin
Page 71 and 72: References Shantharam Baliga B, Rag
Page 73 and 74: References Channon A A, Falkingham
Page 75 and 76: 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
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Appendix 3.2 Garg R, Omwomo W, Witt
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Appendix 3.2 Gupta R, Sachdev H P,
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Appendix 3.2 Hutton G, Schellenberg
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Appendix 3.2 Khandker S R, Latif M
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Appendix 3.2 Lindblade K A, Eisele
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Appendix 3.2 Menéndez C, Bardají
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Appendix 3.2 Nduati R, John G, Mbor
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Appendix 3.2 O'Rourke K (1995a) The
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Appendix 3.2 Prual A, De Bernis L,
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Appendix 3.2 Sabitu K, Alti-Mu'azu
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Appendix 3.2 Smith J B, Coleman N A
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Appendix 3.2 Van Rheenen P, De Moor
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Appendix 3.2 Xiang X, Wang L, Xu L
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Appendix 3.4 Appendix 3.4: Studies
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Appendix 3.4 International Bank for
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Appendix 3.5 Appendix 3.5: Studies
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Orji (2003) (-)/(-) Shihadeh (2001)
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Chinayon (1998) (+)/(+) Kamilya (20
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Nahar (2004) (-)/(-) Tukur (2007) (
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Ndibazza (2010) (++)/(+) Antiretrov
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Bergstrom (1991) (+)/(+) Women with
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Enakpene (2010) (+)/(-) Etuk (2000a
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Pereira (1996) (-)/(-) Saleem (2007
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Author (year) (IV)/(EV) Joshi (2007
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Author (year) (IV)/(EV) Aaby (2005)
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Author (year) (IV)/(EV) Martins (20
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Author (year) (IV)/(EV) de Muylder
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Author (year) (IV)/(EV) Provider mo
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Appendix 4.4: Included items dealin
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Author (year) (IV)/(EV) Target Popu
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Author (year) (IV)/(EV) Colonna (19
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Author (year) (IV)/(EV) Kuhn (2008)
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Author (year) (IV)/(EV) Target popu
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Author (year) (IV)/(EV) Mswia (2003
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Appendix 4.6: Included items dealin
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Appendix 4.8 Appendix 4.8: Economic
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Author (year) (IV)/(EV) and setting
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Appendix 4.9: Included items identi
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Author (year) (IV)/(EV) Poor urban
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Author (year) (IV)/(EV) Poor urban
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Appendix 4.10: High-quality include
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The authors of this report were sup
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