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4. Synthesis results
Summary
Synthesis results
No items were found that specifically tested the effectiveness of different models of
service delivery to reduce maternal and infant mortality among poor urban populations.
Items relevant to interventions targeting poor urban women and infants were
heterogeneous in their focus and study design.
Audit (death reviews) are a low-cost non-clinical intervention that appears to have
positive mortality outcomes for both women and infants.
Kangaroo Mother Care (KMC) was the most tested non-clinical intervention for infants,
with cautious positive impacts on infant mortality.
Complex interventions with positive mortality impacts were localised and heterogeneous
in their impact, even within the study community.
No study looked at the impact that intervention had on poverty nor at how the
intervention was less or more successful because of the poor setting.
Just one study, from Senegal (de Bernis et al., 2000) (+)/(+), used a comparative study
design and showed lower mortality in an area where women had SBA.
4.1 Further details of studies included in the synthesis
The review did not find any items that tested the effectiveness of different models
of service delivery to reduce maternal and infant mortality among poor urban
populations. To the best of our knowledge, there are no studies that address this
issue for this population sub-group. However, we did identify a wide range of
interventions that, whilst not testing different models of service delivery, were
relevant for the research question. The review found extensive heterogeneity of
interventions in terms of both target population and type of intervention. In order to
deal with this heterogeneity, we present our description and discussion of
interventions using four headings for interventions addressing:
Clinical interventions
Surgical/instrumental procedures
Drug treatment (including micronutrient supplementation)
Management of labour (and induction)
Vaccinations
Other clinical management
Non-clinical interventions
Service organisation
Training
Audit
Provider models
Financing
Nutrition (including breastfeeding)
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? 29