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

In general, no overall change of policy was reported. In only one study (Malaba et
al., 2005) was it considered that the Zimbabwean government might have started
recommending postpartum vitamin supplementation as a result of the study (not
confirmed though). Audit was reported to be low cost and high impact (Dumont et
al., 2005; Dumont et al., 2006).
Kangaroo Mother Care is a feasible, low-cost and successful intervention, and
sustainable in resource-poor settings (Cattaneo et al., 1998). However no recent
studies have been found which look at more recent initiatives. More evidence is
needed to assess whether administration of micronutrients for pregnant women
might be sustainable in African countries (Kaestel et al., 2005) , although the
approach (in a paper of medium quality) has been shown to be cost effective in a
south Asian context (Karachi, Pakistan) (Sharieff et al., 2008) (+)/(-).
Jakobsen et al. (2008) highlighted the waste of resource of policies aimed at
breastfeeding-only practices in countries with strong breastfeeding practices.
Synthesis results
Poverty and intervention causality: No study looked at the impact that an
intervention had on poverty nor at how the intervention was less or more successful
because of the poor setting.
Intervention because of poverty: Only one paper considered cash transfers as an
intervention to decrease infant and maternal mortality (Lim et al., 2010) . The
paper highlighted the difficulty in reaching the most disadvantaged groups despite
their being the key focus of the intervention. Infants of urban-based mothers
benefited less from the scheme than mothers in rural areas; similarly, the poorest
decile of the study population benefited least from the cash-transfer scheme.
4.2.4 Urbanity and impact (sustainability)
No study reported a specific intervention which was purposefully done for urban
areas alone. In most cases, the key focus was the poor/low-resource setting. Urban
areas were mostly identified by the location of the hospital/health centre where the
study was conducted. In general there was a lack of reflection on the issues linked to
urban areas and what this entailed for the type of intervention conducted. Possibly
underlying all the studies was the idea that some of the interventions were only
feasible in urban settings. Lim et al. (2010) highlighted the relative lack of progress
in Indian urban areas where it should be easier to get access to services because of
the big investments made through the cash-transfer scheme. Disadvantaged groups
are hard to reach despite regardless of the residence.
Overall the responses seemed to be focused on the short-term impact of the trials on
the key outcomes. Even studies that looked at the impact that audit might have in
the long term did not specifically report on changes in policy. The range of studies
we have considered highlight the need for more long-term evaluations as well as
analysis of the potential effectiveness of interventions that have been evaluated in
low income country settings, but not specifically considered in the context of urban,
poor populations.
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? 48