Birth Preparedness and Complication Readiness (BPCR) interventions to reduce maternal and neonatal mortality in developing countries: systematic review and meta-analysis

Abstract

BackgroundBirth Preparedness and Complication Readiness (BPCR) interventions are widely promoted by governments and international agencies to reduce maternal and neonatal health risks in developing countries; however, their overall impact is uncertain, and little is known about how best to implement BPCR at a community level. Our primary aim was to evaluate the impact of BPCR interventions involving women, families and communities during the prenatal, postnatal and neonatal periods to reduce maternal and neonatal mortality in developing countries. We also examined intervention impact on a variety of intermediate outcomes important for maternal and child survival.MethodsWe conducted a systematic review and meta-analysis of randomized trials of BPCR interventions in populations of pregnant women living in developing countries. To identify relevant studies, we searched the scientific literature in the Pubmed, Embase, Cochrane library, Reproductive health library, CINAHL and Popline databases. We also undertook manual searches of article bibliographies and web sites. Study inclusion was based on pre-specified criteria. We synthesised data by computing pooled relative risks (RR) using the Cochrane RevMan software.ResultsFourteen randomized studies (292 256 live births) met the inclusion criteria. Meta-analyses showed that exposure to BPCR interventions was associated with a statistically significant reduction of 18% in neonatal mortality risk (twelve studies, RR = 0.82; 95% CI: 0.74, 0.91) and a non-significant reduction of 28% in maternal mortality risk (seven studies, RR = 0.72; 95% CI: 0.46, 1.13). Results were highly heterogeneous (I2 = 76%, p < 0.001 and I2 = 72%, p = 0.002 for neonatal and maternal results, respectively). Subgroup analyses of studies in which at least 30% of targeted women participated in interventions showed a 24% significant reduction of neonatal mortality risk (nine studies, RR = 0.76; 95% CI: 0.69, 0.85) and a 53% significant reduction in maternal mortality risk (four studies, RR = 0.47; 95% CI: 0.26, 0.87).Pooled results revealed that BPCR interventions were also associated with increased likelihood of use of care in the event of newborn illness, clean cutting of the umbilical cord and initiation of breastfeeding in the first hour of life.ConclusionsWith adequate population coverage, BPCR interventions are effective in reducing maternal and neonatal mortality in low-resources settings.

Neonatal mortality and associated factors in newborn infants admitted to a Neonatal Care Unit

“…Based on the findings of this study, it is important to know and implement interventions aimed at improving survival among preterm patients, such as specialized care during pregnancy and labor, 2,18,19 antenatal corticosteroid use, 20 and breastfeeding in the first 24 hours, 21 and to increase the resources allocated to health care. 22,23 The limitations of this study are that it was conducted in a hospital sample that may be different from the general population and that the sample was too small to establish specific subgroups, such as mothers < 15 years or who received no antenatal care at all.…”

Birth preparedness and complication readiness in Robe Woreda, Arsi Zone, Oromia Region, Central Ethiopia: a cross-sectional study

“…Meta-analyses showed that exposure to BP/CR interventions was associated with a statistically significant reduction of 18% in neonatal mortality risk (twelve studies, RR = 0.82; 95% CI: 0.74, 0.91) and a non-significant reduction of 28% in maternal mortality risk (seven studies, RR = 0.72; 95% CI: 0.46, 1.13) [13]. …”

Mortalidad neonatal y factores asociados en recién nacidos internados en una Unidad de Cuidados Neonatales

“…4 En pacientes del HCGJIM, no se observó que la edad materna, su escolaridad, el estado civil o la presencia de factores de riesgo, como infección urinaria, ruptura prematura de membranas o corioamnionitis, incrementaran el riesgo de muerte. Dados los hallazgos de este estudio, es importante conocer e implementar intervenciones para mejorar la supervivencia de pacientes prematuros, como la atención especializada del embarazo y el trabajo de parto, 2,18,19 el uso de corticoides prenatales, 20 la lactancia materna en las primeras 24 horas de vida, 21 e incrementar los recursos en cuidados a la salud. 22,23 Las limitaciones de esta investigación son el haberse realizado con una muestra hospitalaria que puede ser diferente a la población general y un tamaño de muestra insuficiente para subgrupos específicos como son madres < 15 años o con nulo control prenatal.…”