Demand-side interventions for maternal care: evidence of more use, not better outcomes

BMC Pregnancy and Childbirth

Lisa R. Hirschhorn²  Atul Gawande³  Manasa Patna⁴  Katherine Semrau¹  Taylor E. Hurst⁵ 

[1] Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA;Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA;Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, USA

关键词: Maternal care;    Quality improvement;    Infant mortality;    Maternal mortality;    Financial incentives;    Community mobilization;    Demand-side;   

Others  :  1232705
DOI  :  10.1186/s12884-015-0727-5

 received in 2015-06-11, accepted in 2015-10-31,  发布年份 2015

【 摘 要 】

Background

Reducing maternal and neonatal mortality is essential to improving population health. Demand-side interventions are designed to increase uptake of critical maternal health services, but associated change in service uptake and outcomes is varied. We undertook a literature review to understand current evidence of demand-side intervention impact on improving utilization and outcomes for mothers and newborn children.

Methods

We completed a rapid review of literature in PubMed. Title and abstracts of publications identified from selected search terms were reviewed to identify articles meeting inclusion criteria: demand-side intervention in low or middle-income countries (LMIC), published after September 2004 and before March 2014, study design describing and reporting on >1 priority outcome: utilization (antenatal care visits, facility-based delivery, delivery with a skilled birth attendant) or health outcome measures (maternal mortality ratio (MMR), stillbirth rate, perinatal mortality rate (PMR), neonatal mortality rate (NMR)). Bibliographies were searched to identify additional relevant papers. Articles were abstracted using a standardized data collection template with double extraction on a sample to ensure quality. Quality of included studies was assessed using McMaster University’s Quality Assessment Tool from the Effective Public Health Practice Project (EPHPP).

Results

Five hundred and eighty two articles were screened with 50 selected for full review and 16 meeting extraction criteria (eight community mobilization interventions (CM), seven financial incentive interventions (FI), and one with both). We found that demand-side interventions were effective in increasing uptake of key services with five CM and all seven FI interventions reporting increased use of maternal health services. Association with health outcome measures were varied with two studies reporting reductions in MMR and four reporting reduced NMR. No studies found a reduction in stillbirth rate. Only four of the ten studies reporting on both utilization and outcomes reported improvement in both measures.

Conclusions

We found strong evidence that demand-side interventions are associated with increased utilization of services with more variable evidence of their impact on reducing early neonatal and maternal mortality. Further research is needed to understand how to maximize the potential of demand-side interventions to improve maternal and neonatal health outcomes including the role of quality improvement and coordination with supply-side interventions.

【 授权许可】

   
2015 Hurst et al.

【 图 表 】

Fig. 1.

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