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Table 4.1: Distribution of high-quality items included in causal chain analysis by
intervention type and target group
Intervention
outcome
Maternal
mortality
Neonatal
mortality
Infant
mortality
Intervention focus
Clinical Non-clinical
Fawzi et al. (2007)
Kaestel et al. (2005)
Munjanja et al.
(1996)
Naz and Mehr-un Nisa
(2005)
Taha et al. (1997)
Darmstadt et al.
(2008)
Kaestel et al. (2005)
Taha et al. (1997)
Benn et al. (2008b)
Benn et al. (2010)
Cobra et al. (1997)
Kumwenda et al.
(2008)
Martins Cesario et al.
(2008)
Malaba et al. (2005)
Dumont et al. (2005)
Dumont et al. (2006)
Lim et al. (2010)
Richard et al. (2008)
Bergsjo et al. (1989)
Cattaneo et al. (1998)
Munjaja et al. (1996)
Becquet et al. (2007)
Cattaneo et al. (1998)
Jakobsen et al. (2008)
Kuhn et al. (2008)
Mbori-Ngacha et al. (2001)
Synthesis results
Only seven (Bergsjo, 1989; Cobra et al. (1997); Taha et al. (1997); Dumont et al.
(2005); Dumont et al. (2006); Darmstadt et al. (2008); Lim et al. (2010)) out of the
21 studies were identified as successful and four had a negative outcome (Malaba et
al., 2005; Jakobsen, 2008; Benn et al, 2010); the remaining 11 were either
inconclusive or did not have a major swing towards positive or negative.
4.2.1 Root causes
Most maternal deaths occur during the intrapartum or a few hours after delivery;
few papers explicitly discussed the root causes of the obstetric complications which
had an impact on both maternal and infant outcome (these were Taha et al., 1997;
Darmstadt et al., 2008; Richard et al., 2008). Lack of staff training combined with
low levels of knowledge were identified as dominant causes for the lack of
implementation of protocols and obstetric care procedures. Social norms in a variety
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? 46