Community‐ based maternal and newborn interventions in Africa: Systematic review

Abstract

Aim and objectives This review analysed the implementation and integration into healthcare systems of maternal and newborn healthcare interventions in Africa that include community health workers to reduce maternal and newborn deaths. Background Most neonatal deaths (99%) occur in low‐ and middle‐income countries, with approximately half happening at home. In resource‐constrained settings, community‐based maternal and newborn care is regarded as a sound programme for improving newborn survival. Health workers can play an important role in supporting families to adopt sound health practices, encourage delivery in healthcare facilities and ensure timeous referral. Maternal and newborn mortality is a major public health problem, particularly in sub‐Saharan Africa, where the Millennium Development Goals 4, 5 and 6 were not achieved at the end of 2015. Methods The review includes quantitative, qualitative and mixed‐method studies, with a data‐based convergent synthesis design being used, and the results grouped into categories and trends. The review took into account the participants, interventions, context and outcome frameworks (PICO), and followed the adapted PRISMA format for reporting systematic reviews of the qualitative and quantitative evidence guide checklist. Results The results from the 17 included studies focused on three themes: antenatal, delivery and postnatal care interventions as a continuum. The main components of the interventions were inadequate, highlighting the need for improved planning before each stage of implementation. A conceptual framework of planning and implementation was elaborated to improve maternal and newborn health. Conclusion The systematic review highlight the importance of thoroughly planning before any programme implementation, and ensuring that measures are in place to enable continuity of services. Relevant to the clinical practice Conceptual framework of planning and implementation of maternal and newborn healthcare interventions by maternal community health workers.

Where is the ‘C’ in antenatal care and postnatal care: A multi‐country survey of availability of antenatal and postnatal care in low‐ and middle‐income settings

“…Recently there have been suggestions that community-based healthcare workers and/or volunteers may be better placed to provide postnatal care and follow-up. 35,36 Although this is likely to be cost-effective and may result in more women receiving a visit in the postnatal period, careful planning is needed for effective implementation 37,38 A multi-country mapping shows that few community-based healthcare providers are adequately trained and competent, legislated and/or supported to provide all of the essential components of either ANC or PNC. 39,40…”

Community mobilization to strengthen support for appropriate and timely use of antenatal and postnatal care: A review of reviews

“…However, the complexity of these interventions as well as the lack of information on implementation processes advocate for further studies that provide this additional detail on community mobilization’s implications for ANC/PNC support and uptake. Reviews published as recently as 2021 perpetuate the same pattern by labeling one-sided didactic programs as “community participation” or failing to describe what comprised the community mobilization component of a program [ 73 , 74 ]. Furthermore, while the reviews show a large geographic range in terms of countries and SDG regions included, the relevance of context in community-based interventions emphasizes the importance of considering localized and country/region-specific findings.…”

Interventions to enhance healthcare utilisation among pregnant women to reduce maternal mortality in low- and middle-income countries: a review of systematic reviews

“…To accelerate progress towards this goal, simple, cost-effective interventions to increase healthcare utilisation among pregnant women must be implemented or scaled up in LMIC. Several systematic reviews have identi ed, evaluated, and summarised the ndings from relevant individual studies of effective interventions [18][19][20][21][22]. We aimed to synthesize evidence from systematic reviews on interventions to improve healthcare service utilisation among pregnant women in LMICs to reduce maternal mortality.…”