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Synthesis results
Four studies focused on the induction of labour. Two of these focused on induction
for women with eclampsia (Nahar et al., 2004 (-)/(-); Tukur et al., 2007 (+)/(-)) by
means of misoprostol (50mg). There did not appear to be any advantage of
misoprostol in terms of mortality in either study, although Nahar et al. (2004) (-)/(-
); was able to conclude that intravaginal misoprostol was well tolerated and
effective in the induction of labour. The third study considered induction of labour
in the context of women going beyond 42 weeks gestation (Bergsjo et al., 1989) (-
)/(-). Induction by stripping of membranes and intravenous oxytocin infusion in this
context offered no advantage as measured by perinatal mortality. Abdul et al.
(2007) (-)/(+) compared misoprostol to oxytocin as drugs for induction during the
third stage of labour. No deaths were recorded in either group and the efficacy of
misoprostol was judged to be comparable to oxytocin.
Three studies concerned the assessment of micronutrient supplements. These have
been classified under ‘drug treatments’ as they were prescribed within a clinical
setting. Fawzi et al. (2007) (++)/(++) compared daily multivitamins (vitamins B, C, E)
with a placebo group in HIV-negative women in Tanzania. No benefits were found in
terms of risk of prematurity and foetal death in the treatment group but there was
significantly reduced risk of low birthweight (LBW) compared to the placebo group.
Kaestel et al. (2005) (++)/(++) compared different levels of micronutrient
supplements for pregnant women in Guinea-Bissau but found no differences in
perinatal or neonatal mortality. Kupka et al. (2008) (++)/(-) also found no significant
effect of selenium supplementation for HIV-infected pregnant women in terms of
maternal or neonatal mortality.
Ndibazza et al. (2010) (++)/(+) and de Silva et al. (1999) (+)/(++) evaluated the
impact of the use of anthelmintics to expel parasitic worms by women during
pregnancy on perinatal mortality. In Sri Lanka, de Silva et al. (1999) (+)/(++) found
perinatal deaths to be lower in the anthelmintic group, whereas Ndibazza et al.
(2010) (++)/(+) found no overall effect in an area in Uganda where helminth
prevalence was high but infection intensity low.
Two studies focused on the use of antiretrovirals in HIV-infected pregnant women
(Ekouevi et al., 2008 (+)/(-); Walter et al., 2006 (+)/(+)). The use of highly active
antiretroviral treatment (HAART) was found to have no benefit as measured by
stillbirths among women with advanced HIV (Ekouevi et al., 2008) (+)/(-) but
antiretroviral treatment for HIV-infected pregnant women with low CD4 counts was
found to significantly decrease neonatal mortality in a study in Zambia.
Two studies focused on the use of antibiotics, but in different contexts. Aboud et al.
(2009) (++)/(+) assessed the effect of giving antibiotics to HIV-infected pregnant
women. No benefits were found in terms of maternal morbidity or mortality.
Bergstrom (1991) (+)/(+) assessed the use of antibiotics in the conservative
management of women with preterm rupture of membranes. Neonatal mortality was
found to be significantly lower than in a control group in which no pharmaceutical
treatment was given but labour was induced.
The remaining papers involved single studies looking at different aspects of drug
treatment: the use of steroids in women with high-risk premature delivery (Fekih et
al., 2002) (+)/(-); use of misoprostol in the active management of third stage of
labour (Afolabi et al., 2010) (+)/(-); use of injectable contraceptive during
pregnancy (Gray and Pardthaisong, 1991) (+)/(+); and administration of the
antimalarial, quinine hydrochloride, for pregnant women with malaria (Kietinun et
al., 1993) (-)/(-). All except Gray and Pardthaisong (1991) reported favourable
outcomes for the drug treatment evaluated.
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? 31