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Strengths and limitations
meant that we did not do more than a cursory search of several databases
identified in our initial strategy (Appendix 2.2). In saying this, the functionality of
the main databases used in this review, including PubMed and POPLINE, had
reasonable functionality. Some databases also did not include abstracts as part of
their bibliographic records, limiting their usefulness. This potentially means that
we may have missed some relevant studies, although we have searched through a
broad range of databases in health, development and social sciences. We have also
tried to counter any limitations through running a number of more limited search
strategies on these databases, as well as through citation searching of references
of included studies and handsearching of a number of key journals and websites.
Despite searches of a range of governmental and international agencies, nongovernmental
organisations and some other websites, and searching databases that
picked up on discussion papers and theses, there may also be additional grey
literature sources that might have been searched in more detail had resources
permitted.
5.2 Scope of review
It is also important to acknowledge that by restricting the focus of our review to
studies that had maternal or infant mortality as one of the outcomes, as indicated
in our revised protocol, we have certainly excluded bodies of evidence related to
non-mortality maternal and infant health outcomes in poor urban populations,
including those that produced a large volume of evidence. This includes work
produced by, for example, Cooper et al. (2002) and colleagues in a poor peri-urban
location (Khayelitsha) in South Africa, work by the African Population and Health
Research Center (APHRC, 2002a, 2002b) in Nairobi, and a range of individual
studies (e.g. Mullany et al., 2007). Qualitative studies that looked at the reasons
for uptake and continued participation in maternal and infant health services, but
did not look at the relationship with changes in mortality outcomes were excluded
from the analysis, but would also have been a valuable additional source of
information. Such studies could also have helped in understanding the impacts of
different contexts and cultures on the use of services. For instance Fotso et al.
(2009a, 2009b) looked at factors that influenced women’s maternal health service
seeking behaviours in the slums of Nairobi.
We have already acknowledged that there were major problems in identifying
‘poor’ populations – we took an inclusive strategy and included measures that are
frequently used as proxies for ‘poor’. Indeed when we read full text articles, it
became clear that many studies, while implicitly focusing on individuals in poor
countries, did not specifically report socio-economic status or other measures of
poverty.
The quality and heterogeneity of studies identified has also meant that we have
had to undertake a narrative review rather than meta analyses.
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? 54