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Synthesis results resource-poor settings, whilst not a controlled experimental study, provided convincing evidence for significant impact on early neonatal mortality rates. The final successful intervention addressing maternal mortality involved a change to service intervention in Senegal (Dumont et al., 2005), and it is worth noting that it referred to the same setting as that in Dumont et al. (2006) in Table 4.1, namely, the introduction of routine audits of maternal deaths as a tool to improve service delivery, underlining the importance of facility-based quality improvement measures. MDR does appear to be another relatively low cost and high impact intervention. 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? 52
5. Strengths and limitations Summary Limitations include: Bias towards English language literature Bias against modelling-based economic evaluations Strengths and limitations Restriction to maternal or infant mortality outcomes, excluding non-mortality health outcomes for mothers and infants Problems in identifying ‘poor’ populations and reliance on the use of proxies for ‘poor’ 5.1 Search strategy There are a number of limitations in our review. One key issue is a bias towards English language literature. By restricting our search strategy to largely English language databases, we may have missed relevant studies in other languages, this is despite the fact that some databases do provide English language abstracts for non-English language papers. We have tried to mitigate against this by examining relevant papers in French, Spanish and Italian. Moreover, while we do not have the resources for additional translation, we have also sought to identify potentially relevant papers in other languages whose English language abstracts appear relevant. In developing and refining our search strategy, it became clear that it would be difficult to come up with a comprehensive set of terms to cover the many different definitions of poverty and urbanicity. We sought to counter this risk by not including any specific poverty or urbanicity terms in our search strategy, and instead sought to identify studies that looked at maternal and child health in our target countries and then to determine whether these studies did focus on our target population. Our study protocol indicated that we would make our initial decisions on inclusion/exclusion on the basis of study abstracts/summaries. However it had to be acknowledged that relevant papers might not provide sufficient detail on target population to judge whether a paper focused on urban, poor populations from the abstract alone. We tried to account for this by erring on the side of retrieval of full text papers where a study appeared relevant in all respects other than having an indication of geographical location or socio-economic status of the target population. Our primary search strategy may also not have been sensitive enough to pick up economic evaluations which were based on modelling rather than empirical studies; while we did search both Econlit and the NHS Economic Evaluation Database, a supplemental search of several key databases making use of key economic evaluation terms was conducted to see whether any additional studies could be identified, including the Office of Health Economics Health Economics Evaluation Database (HEED). Given the limited number of effectiveness studies that looked at interventions specifically for urban populations and reported maternal and/or infant mortality outcomes, this is not surprising. Another challenge has been the limited functionality of some databases, which in some cases have made it difficult to construct complex search strategies and/or to import records electronically into EndNote. In some cases, the lack of functionality 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? 53
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Systematic review What are the effe
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Contents List of abbreviations ....
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List of abbreviations AIDS Acquired
Page 7 and 8: Executive summary Background Execut
Page 9 and 10: Executive summary be to retrospecti
Page 11 and 12: Background many LICs and LMCs, it i
Page 13 and 14: Background Cross-sectional surveys
Page 15 and 16: Background For some causes of mater
Page 17 and 18: Background informal settlements on
Page 19 and 20: Background review focused on explic
Page 21 and 22: Types of intervention Interventions
Page 23 and 24: Box 2.2: Websites searched AFD (Age
Page 25 and 26: second stage previously described f
Page 27 and 28: using qualitative analysis to attem
Page 29 and 30: Figure 3.1: Filtering of papers fro
Page 31 and 32: Middle East and North Africa (8%) S
Page 33 and 34: Search results access or satisfacti
Page 35 and 36: 4. Synthesis results Summary Synthe
Page 37 and 38: Synthesis results Four studies focu
Page 39 and 40: Drug treatments (including micronut
Page 41 and 42: Synthesis results Training and audi
Page 43 and 44: Synthesis results order to be effec
Page 45 and 46: Synthesis results government admini
Page 47 and 48: HIV/AIDS and Malaria, as well as no
Page 49 and 50: Synthesis results ASSESSING THE COS
Page 51 and 52: and birthing care services, includi
Page 53 and 54: Synthesis results of settings were
Page 55 and 56: Figure 4.1: Causal chain for matern
Page 57: 4.3 Summary of results of causal ch
Page 61 and 62: 6. Conclusions and recommendations
Page 63 and 64: Conclusions and recommendations Urb
Page 65 and 66: References Bakr A F, Karkour T (200
Page 67 and 68: References Deschamps M M, Noel F, B
Page 69 and 70: References Lim S, Dandona L, Hoisin
Page 71 and 72: References Shantharam Baliga B, Rag
Page 73 and 74: References Channon A A, Falkingham
Page 75 and 76: References Jowett M (2000) Safe Mot
Page 77 and 78: References Rice J, Rice J S (2009)
Page 79 and 80: Appendices Appendix 1.1: Authorship
Page 81 and 82: Appendix 2.1: Inclusion and exclusi
Page 83 and 84: Appendix 2.2: Search strategy for e
Page 85 and 86: Appendix 2.2 Infant* OR Matern* OR
Page 87 and 88: OR/ 12-13 11 AND 14 Limit 15 to pub
Page 89 and 90: Appendix 2.4: Journals handsearched
Page 91 and 92: POOR PROFILE Is the study populatio
Page 93 and 94: infants (
Page 95 and 96: Appendix 2.5 Intervention (surgical
Page 97 and 98: Appendix 2.5 Intervention (service
Page 99 and 100: MORTALITY OUTCOME TYPES Which morta
Page 101 and 102: positive neutral negative unclear/n
Page 103 and 104: yes no unclear/not stated N/A Study
Page 105 and 106: surveillance system none of the abo
Page 107 and 108: no SELECTION CHARACTERISTICS Is inf
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Appendix 2.5 QUANTITATIVE DATA ADJU
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RESEARCHER RELATIONSHIP Has the rel
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Were the inclusion/exclusion criter
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person-years). 3.5 Was follow-up ti
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Appendix 2.7 Appendix 2.7: Quality
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triangulation, or for not triangula
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Was the study approved by an ethics
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Item Yes No Not clear 3. The viewpo
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Appendix 2.9: Electronic databases
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Web of Knowledge (including ISI Cit
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Study Setting Intervention type Abo
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Study Setting Intervention type Alw
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Study Setting Intervention type Ben
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Study Setting Intervention type Ble
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Study Setting Intervention type Cob
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Study Setting Intervention type Des
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Study Setting Intervention type Faw
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Study Setting Intervention type Jak
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Study Setting Intervention type Kup
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Study Setting Intervention type Mar
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Study Setting Intervention type Nah
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Study Setting Intervention type Pad
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Study Setting Intervention type Str
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Study Setting Intervention type Zia
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Appendix 3.2 Adam G K, Abdulla M A,
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Appendix 3.2 Balkus J, Bosire R, Jo
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Appendix 3.2 Boerma J T, Stroh G (1
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Appendix 3.2 Chiwuzie J, Okojie O,
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Appendix 3.2 De Alencar A E, Arraes
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Appendix 3.2 Ekman B, Pathmanathan
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Appendix 3.2 Garg R, Omwomo W, Witt
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Appendix 3.2 Gupta R, Sachdev H P,
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Appendix 3.2 Hutton G, Schellenberg
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Appendix 3.2 Khandker S R, Latif M
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Appendix 3.2 Lindblade K A, Eisele
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Appendix 3.2 Menéndez C, Bardají
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Appendix 3.2 Nduati R, John G, Mbor
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Appendix 3.2 O'Rourke K (1995a) The
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Appendix 3.2 Prual A, De Bernis L,
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Appendix 3.2 Sabitu K, Alti-Mu'azu
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Appendix 3.2 Smith J B, Coleman N A
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Appendix 3.2 Van Rheenen P, De Moor
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Appendix 3.2 Xiang X, Wang L, Xu L
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Appendix 3.4 Appendix 3.4: Studies
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Appendix 3.4 International Bank for
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Appendix 3.5 Appendix 3.5: Studies
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Orji (2003) (-)/(-) Shihadeh (2001)
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Chinayon (1998) (+)/(+) Kamilya (20
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Nahar (2004) (-)/(-) Tukur (2007) (
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Ndibazza (2010) (++)/(+) Antiretrov
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Bergstrom (1991) (+)/(+) Women with
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Enakpene (2010) (+)/(-) Etuk (2000a
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Pereira (1996) (-)/(-) Saleem (2007
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Author (year) (IV)/(EV) Joshi (2007
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Author (year) (IV)/(EV) Aaby (2005)
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Author (year) (IV)/(EV) Martins (20
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Author (year) (IV)/(EV) de Muylder
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Author (year) (IV)/(EV) Provider mo
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Appendix 4.4: Included items dealin
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Author (year) (IV)/(EV) Target Popu
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Author (year) (IV)/(EV) Colonna (19
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Author (year) (IV)/(EV) Kuhn (2008)
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Author (year) (IV)/(EV) Target popu
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Author (year) (IV)/(EV) Mswia (2003
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Appendix 4.6: Included items dealin
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Appendix 4.8 Appendix 4.8: Economic
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Author (year) (IV)/(EV) and setting
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Appendix 4.9: Included items identi
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Author (year) (IV)/(EV) Poor urban
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Author (year) (IV)/(EV) Poor urban
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Appendix 4.10: High-quality include
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The authors of this report were sup
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