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Childbirth attendance strategies and their impact on maternal mortality and morbidity in low-income settings: a systematic review

Authors

  • THIDAR PYONE,

    1. Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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  • BJARKE LUND SORENSEN,

    1. Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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  • SIRI TELLIER

    1. Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Conflict of interest
    The authors have stated explicitly that there are no conflicts of interest in connection with this article.

  • Please cite this article as: Pyone T, Sorensen BL, Tellier S. Childbirth attendance strategies and their impact on maternal mortality and morbidity in low-income settings: a systematic review. Acta Obstet Gynecol Scand 2012; 91:1029–1037.

Thidar Pyone, Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, CSS, Mailbox 2099, DK-1014 Copenhagen K, Denmark. E-mail: tdpyone@gmail.com

Abstract

Objective. To review quantitative evidence of the effect on maternal health of different childbirth attendance strategies in low-income settings. Design. Systematic review. Methods. Studies using quantitative methods, referring to the period 1987–2011, written in English and reporting the impact of childbirth attendance strategies on maternal mortality or morbidity in low-income settings were included. Guidelines developed by the Cochrane collaboration and the Centre for Review and Dissemination, University of York were followed. The included articles were read and sorted by category of strategy that emerged from the reading. Results. The search criteria yielded 29 articles. The following three main categories of strategy emerged: (i) those primarily intended to improve quality of care; (ii) “centrifugal strategies,” which sought to bring services to the women; and (iii) “centripetal strategies,” which sought to bring the women to the services. Few of the studies had a design that provided strong evidence for the impact of the strategy concerned. Conclusions. The evidence emerging from the studies was difficult to compare, because concepts were not defined in a consistent manner (such as “skilled birth attendance”) and many studies examined the impact of a package of interventions without ferreting out the impact of individual components. Yet, some studies described individual aspects with great promise (such as cost, transport, outreach-friendly drugs or targeted training). There is a need for clearer conceptual frameworks, including some which permit assessment of packages of interventions.

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