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

More documents

Recommendations

Info

Conclusions and recommendations very little. Only one paper (de Bernis et al., 2000) (+)/(+) looked specifically at the link between service delivery and maternal mortality and morbidity for urban populations with contrasting health care service provision. This study, from Senegal, showed that an area where women were more likely to deliver in hospitals with trained midwives had lower levels of maternal mortality than an area where most women gave birth in district health centres, usually assisted by TBAs, implying that access to skilled health care is fundamental. Given that the distribution of women by socio-economic groups was very similar in both communities, most of the effect could be attributed to these differentials in service provision. Our searches and analyses encountered major problems in identifying ‘poor’ populations. Whilst we took an inclusive strategy and included measures that are frequently used as proxies for ‘poor’ (e.g., material ownership indices), much of the evidence uncovered by our searches treated terms such as ‘poor’ and ‘poverty’ as unproblematic – especially that produced in the medical literature. There is a need for greater clarity about the definitions used for common measures (e.g., urban, poor, poverty) in the reporting of interventions in the literature. Without this clarity, the potential usefulness of high-quality studies for understanding what works to improve the health of the urban poor is greatly reduced. Secondary analyses of datasets such as the DHS and MICS are widely used in the study of the urban poor (and many were identified in our initial searches but excluded from the review). Such datasets represent an important source of descriptive information, but their explanatory power is very limited, even when data are disaggregated to identify the urban poor in wealth quintiles based on material ownership. The evidence base, where it does disaggregate and identify (however loosely) the urban poor, tends to compare and contrast with rural populations. Whilst this approach is intuitive and relatively easy to operationalise, especially for secondary analyses of large-scale datasets such as the DHS, we need to remember that ‘the urban health goal is not simply to be better on average than rural areas. The ambition must be to attain good health for all absolutely’ (Dye, 2008, p.768). What, then, are the methodological issues involved in studying the health of poor urban people? Our review found few studies for inclusion that acknowledged and studied the urban poor as an individual (highly heterogeneous) group. Many descriptive studies either compare urban poor with urban non-poor and/or rural populations. Poor urban settings can introduce methodological issues that make intervention delivery and evaluation difficult, above and beyond those limitations that might exist in a LIC setting. However, it is important to remember that poor urban populations do not just live in slums or informal settlements. There are many poor urbanites who do not live within slums. Non-slum dwelling urban poor are just as ‘invisible’ in the evidence our search produced. There is a lag between researchers’ (and funders’) intervention research interests, but also, we would argue, a degree of inertia. Long-term funding for non-urban poor settings that evaluate health interventions make compelling arguments for continued funding, in part to protect time series data. Many longitudinal study sites in more rural settings have made efforts to capture population movements to and from urban areas (Collinson and Adazu, 2006). However, the continued concentration of, for example, Demographic Surveillance Sites in LICs and LMCs in largely rural settings means that data with explanatory power continue to be absent for many urban poor. 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? 56
Conclusions and recommendations Urban upgrading programmes (also called slum upgrading or improvement programmes) are complex interventions and can include better provision of health services in general and MCH services in particular as part of a bundle of services (Field and Kremer, 2006). Given that MDG7 Target 11 ‘By 2020, to have achieved a significant improvement in lives of at least 100 million slum dwellers’ has generated the production and consumption of much data about slum dwellers’ lives, it was surprising that we found no relevant MCH evidence produced by evaluations before and after urban upgrading. Urban upgrading evaluations have tended to rely on changes in tenure and access to water and sanitation. Even when health outcomes are the focus, research has tended to evaluate the impact on infectious diseases (for example, Butala et al., 2010). One forthcoming item we did identify was the proposed 3ie synthetic review Slum Upgrading Strategies and Their Effects on Health and Social Outcomes by Saith et al. (forthcoming), as yet not released. 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? 57
Page 1 and 2:
Systematic review What are the effe
Page 3 and 4:
Contents List of abbreviations ....
Page 5 and 6:
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 and 58: 4.3 Summary of results of causal ch
Page 59 and 60: 5. Strengths and limitations Summar
Page 61: 6. Conclusions and recommendations
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
Page 109 and 110: Appendix 2.5 QUANTITATIVE DATA ADJU
Page 111 and 112: RESEARCHER RELATIONSHIP Has the rel
Page 113 and 114:
Were the inclusion/exclusion criter
Page 115 and 116:
person-years). 3.5 Was follow-up ti
Page 117 and 118:
Appendix 2.7 Appendix 2.7: Quality
Page 119 and 120:
triangulation, or for not triangula
Page 121 and 122:
Was the study approved by an ethics
Page 123 and 124:
Item Yes No Not clear 3. The viewpo
Page 125 and 126:
Appendix 2.9: Electronic databases
Page 127 and 128:
Web of Knowledge (including ISI Cit
Page 129 and 130:
Study Setting Intervention type Abo
Page 131 and 132:
Study Setting Intervention type Alw
Page 133 and 134:
Study Setting Intervention type Ben
Page 135 and 136:
Study Setting Intervention type Ble
Page 137 and 138:
Study Setting Intervention type Cob
Page 139 and 140:
Study Setting Intervention type Des
Page 141 and 142:
Study Setting Intervention type Faw
Page 143 and 144:
Study Setting Intervention type Jak
Page 145 and 146:
Study Setting Intervention type Kup
Page 147 and 148:
Study Setting Intervention type Mar
Page 149 and 150:
Study Setting Intervention type Nah
Page 151 and 152:
Study Setting Intervention type Pad
Page 153 and 154:
Study Setting Intervention type Str
Page 155 and 156:
Study Setting Intervention type Zia
Page 157 and 158:
Appendix 3.2 Adam G K, Abdulla M A,
Page 159 and 160:
Appendix 3.2 Balkus J, Bosire R, Jo
Page 161 and 162:
Appendix 3.2 Boerma J T, Stroh G (1
Page 163 and 164:
Appendix 3.2 Chiwuzie J, Okojie O,
Page 165 and 166:
Appendix 3.2 De Alencar A E, Arraes
Page 167 and 168:
Appendix 3.2 Ekman B, Pathmanathan
Page 169 and 170:
Appendix 3.2 Garg R, Omwomo W, Witt
Page 171 and 172:
Appendix 3.2 Gupta R, Sachdev H P,
Page 173 and 174:
Appendix 3.2 Hutton G, Schellenberg
Page 175 and 176:
Appendix 3.2 Khandker S R, Latif M
Page 177 and 178:
Appendix 3.2 Lindblade K A, Eisele
Page 179 and 180:
Appendix 3.2 Menéndez C, Bardají
Page 181 and 182:
Appendix 3.2 Nduati R, John G, Mbor
Page 183 and 184:
Appendix 3.2 O'Rourke K (1995a) The
Page 185 and 186:
Appendix 3.2 Prual A, De Bernis L,
Page 187 and 188:
Appendix 3.2 Sabitu K, Alti-Mu'azu
Page 189 and 190:
Appendix 3.2 Smith J B, Coleman N A
Page 191 and 192:
Appendix 3.2 Van Rheenen P, De Moor
Page 193 and 194:
Appendix 3.2 Xiang X, Wang L, Xu L
Page 195 and 196:
Appendix 3.4 Appendix 3.4: Studies
Page 197 and 198:
Appendix 3.4 International Bank for
Page 199 and 200:
Appendix 3.5 Appendix 3.5: Studies
Page 201 and 202:
Orji (2003) (-)/(-) Shihadeh (2001)
Page 203 and 204:
Chinayon (1998) (+)/(+) Kamilya (20
Page 205 and 206:
Nahar (2004) (-)/(-) Tukur (2007) (
Page 207 and 208:
Ndibazza (2010) (++)/(+) Antiretrov
Page 209 and 210:
Bergstrom (1991) (+)/(+) Women with
Page 211 and 212:
Enakpene (2010) (+)/(-) Etuk (2000a
Page 213 and 214:
Pereira (1996) (-)/(-) Saleem (2007
Page 215 and 216:
Author (year) (IV)/(EV) Joshi (2007
Page 217 and 218:
Author (year) (IV)/(EV) Aaby (2005)
Page 219 and 220:
Author (year) (IV)/(EV) Martins (20
Page 221 and 222:
Author (year) (IV)/(EV) de Muylder
Page 223 and 224:
Author (year) (IV)/(EV) Provider mo
Page 225 and 226:
Appendix 4.4: Included items dealin
Page 227 and 228:
Author (year) (IV)/(EV) Target Popu
Page 229 and 230:
Author (year) (IV)/(EV) Colonna (19
Page 231 and 232:
Author (year) (IV)/(EV) Kuhn (2008)
Page 233 and 234:
Author (year) (IV)/(EV) Target popu
Page 235 and 236:
Author (year) (IV)/(EV) Mswia (2003
Page 237 and 238:
Appendix 4.6: Included items dealin
Page 239 and 240:
Appendix 4.8 Appendix 4.8: Economic
Page 241 and 242:
Author (year) (IV)/(EV) and setting
Page 243 and 244:
Appendix 4.9: Included items identi
Page 245 and 246:
Author (year) (IV)/(EV) Poor urban
Page 247 and 248:
Author (year) (IV)/(EV) Poor urban
Page 249 and 250:
Appendix 4.10: High-quality include
Page 251:
The authors of this report were sup
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?