Full Report - Research for Development - Department for ...

Drug treatments (including micronutrient supplementation)
Vaccinations
Other clinical management
Surgical/instrumental procedures
Only one study aimed at improving infant mortality outcomes was focused on
surgical intervention. In a retrospective study based in Amman, Jordan, Ziadeh
(2000) (-)/(-) sought to determine the perinatal outcomes associated with triplet
pregnancies and compare outcomes for Caesarean section with vaginal delivery.
Caesarean section was not found to be advantageous but the sample size was very
small (n=41).
Synthesis results
Drug treatments (including micronutrient supplementation)
Six papers focused on drug treatments. One study focused on the use of drug
treatments to improve infant outcomes (Kumwenda et al., 2008) (++)/(++). This
randomised controlled trial in Malawi evaluated extended antiretroviral prophylaxis
to reduce breast-milk HIV-1 transmission. Extended prophylaxis for the first 14
weeks of life significantly reduced postnatal HIV-1 transmission at 9 months but
there was not a significant difference in mortality at this stage of follow-up.
Five studies focused on micronutrient supplementation to improve infant mortality
outcomes. A randomised controlled trial in urban Zimbabwe (Malaba et al., 2005)
(++)/(++) measured the effect on infant mortality of supplementing neonates and
their HIV-negative mothers with single, large doses of vitamin A during the
immediate postpartum period, but found no significant impact. A controlled
experimental study located in a peri-urban Indonesian community (Cobra et al.,
1997) (++)/(++) showed a positive impact on infant mortality outcomes as a result of
oral iodine supplementation. The study concluded that in populations at risk of
iodine deficiency, oral iodized oil supplementation of infants may reduce infant
mortality. Furthermore, a study from China examined the effect of water treatment
with iodine on infant and neonatal mortality (de Long et al., 1997) (+)/(+). The
authors concluded that iodine replacement through iodination of irrigation water
was possibly an important factor in the recorded decline in infant mortality in China
in areas with severe iodine deficiency. Finally, in Egypt, increased availability of oral
rehydration salts (ORS) was associated with an improvement in the case
management of, and mortality from, diarrhoea (Miller et al., 1994) (+)/(++).Finally,
Joshi et al. (2007) (-)/(-) showed that inhalational nitric oxide (INO) can be life
saving and cost-effective in a LIC setting such as India.
Vaccinations
Eleven papers focused on vaccinations. All studies on vaccinations included in this
review focused on infant outcomes. Vaccination remains a key prevention tool to
reduce IMR in low resource settings. This review found 10 studies looking at ways to
implement vaccination programmes to improve infant and neonatal mortality. Amin
et al. (1992) (-)/(-) looked at the impact of the Expanded Program on Immunization
in Sierra Leone and found that immunisation had a dramatic effect on infant
mortality declines between 1975 and 1990. A series of studies from Guinea Bissau
provide evidence relating to measles and BCG vaccinations and their impact on
infant mortality. Aaby et al. (2002) (+)/(+), working in urban, peri-urban and rural
areas of Guinea Bissau, compared measles-vaccinated children with those not
vaccinated, and the former showed significantly lower levels of mortality. Martins
Cesario et al. (2008) (++)/(++) further confirmed the results, showing that outbreaks
of measles can be curtailed by giving the measles vaccine as early as 4.5 months of
age. Bacillus Calmette-Guerin (BCG) vaccine on the other hand does not show
straightforward results. Garly et al. (2003) (+)/(-), also working in a peri-urban area
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? 33