Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand

Abstract

Background: Although a number of antenatal and intrapartum interventions have shown some evidence of impact on stillbirth incidence, much confusion surrounds ideal strategies for delivering these interventions within health systems, particularly in low-/middle-income countries where 98% of the world's stillbirths occur. Improving the uptake of quality antenatal and intrapartum care is critical for evidence-based interventions to generate an impact at the population level. This concluding paper of a series of papers reviewing the evidence for stillbirth interventions examines the evidence for community and health systems approaches to improve uptake and quality of antenatal and intrapartum care, and synthesises programme and policy recommendations for how best to deliver evidence-based interventions at community and facility levels, across the continuum of care, to reduce stillbirths.

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

“…Although few studies have been done in lowincome and middle-income countries, reported eff ect sizes range from small to moderate for improved provider prac tices [61][62][63] and are large for drug management 64 and perinatal and intrapartum mortality. 64,65 Increased supervision is another strategy used to improve health-worker performance in low-income and middle-income countries and has moderate-to-large eff ects.…”

The interconnections between maternal and newborn health – evidence and implications for policy

“…To support the basic primary health care infrastructure, a range of different approaches have been developed to train CHWs to provide specific tasks related to antenatal and postnatal care [216,277]. These trained CHWs deliver these interventions to the community via different strategies, such as community mobilization and home visitation.…”

“…Impact estimates: The review by Hundley et al [213] identified intervention packages which include CDKs to reduce risk for maternal puerperal sepsis (OR 0.17; 95% CI: 0.13 to 0.23) [214], neonatal infectious morbidity such as sepsis (RR 0.12; 95% CI: 0.02 to 0.93) [215], and omphalitis (OR 0.42; 95% CI: 0.18 to 0.97 [215]; (OR 0.08; 95% CI: 0.03 to 0.19) [216,217]. Available studies show that the provision of CDKs has a statistically significant impact on perinatal/ neonatal mortality ((OR 0.7; 95% CI: 0.59 to 0.82) [79]; (RR 0.17; 95% CI: 0.13 to 0.23) [214,218,219]; (OR 0.78; 95% CI: 0.50 to 1.21) [29]).…”

A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries

“…9,21,22 In these situations, it may not always be possible to transfer a woman to an emergency obstetric care facility in time to perform a life-saving procedure should the need arise. [23][24][25] Furthermore, as more emphasis is placed on delivery at health-care facilities and as women become more aware of the benefits, there has been an increase in the workload at referral hospitals in low-resource areas, many of which are underequipped and understaffed. [25][26][27] Thus, even when a referral is made, the quality of care is often inadequate, especially for women who arrive late with a complication.…”