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

Executive summary
Background
Executive summary
The burden of maternal and infant deaths falls disproportionately on low income
countries (LICs) and lower middle income countries (LMCs 1 ) and among the poorest
within these countries. The causes of maternal and infant mortality and morbidity
are well established, yet knowledge on effective management of conditions has not
been translated into significantly improved outcomes because of a lack of
resources and effective models of service delivery. Urban populations are often
assumed to have better access to health care than those living in rural areas.
However, urban health systems in many LICs and LMCs have a weak to non-existent
public health structure and lack uniform implementation of strategies and
necessary infrastructures. Given rapid urbanisation in many LICs and LMCs it is now
crucial to establish evidence-based approaches to improving access to and uptake
of maternal and infant care models in urban areas and improving quality of services
in order to improve maternal and child outcomes. Whilst the medical solutions for
preventing maternal and infant mortality are known, delivering these solutions is a
considerable challenge in proximity to urban slums.
Objectives
This systematic review addresses the question:
Methods
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?’
Our systematic review focused on explicit evaluations of interventions aimed at
improving health outcomes for poor people in urban areas. The review focused on
maternal, infant, neonatal, perinatal and post-neonatal mortality outcomes, but
also included maternal and infant health outcomes. Our review team, including
information scientists and information retrieval experts, developed a search
protocol and search terms that were subject to external peer review. Our search
includes major databases that cover literature on this topic; these cover both
English and non-English language material, including specialist health and
development databases, as well as those focusing on specific geographical areas. A
comprehensive search was conducted of published and unpublished materials. The
search followed the study protocol, which set out the search strategy and selection
methods. The study used multiple approaches to data analysis (including:
narrative; cost-effectiveness; understanding links between the cause, approaches,
outcomes and sustainability of change as part of a causal chain analysis) to assess
not only which interventions are effective (or not), but how and under what
circumstances. Quantitative and qualitative data were collected from and coded
for included items, and each item was coded for a range of variables. Interventions
were grouped into clinical and non-clinical categories. We collected qualitative
evidence on contextual factors and causal pathways that may help to explain why
interventions were (in)effective.
1 We used the World Bank classification: http://data.worldbank.org/about/country-classifications
(accessed 10 March 2011).
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? 1