已经实施了许多干预措施来改善撒哈拉以南非洲(SSA)的孕产妇健康结果。目前,然而,关于这些干预措施有效性的系统信息仍然很少。我们对已发表的关于非药物干预措施的证据进行了系统评价,这些证据报告了改善SSA孕产妇健康结局和护理质量的有效性。
非洲在线期刊,Bioline,MEDLINE,奥维德,科学直接,我们在Scopus数据库中搜索了2000年至2015年间发表的英文研究,并报告了改善SSA孕产妇保健质量和结局的干预措施的有效性.文章侧重于涉及药物治疗的干预措施,药物,或治疗被排除。我们提供了这些干预措施对孕产妇发病率和死亡率结果以及孕产妇保健质量的其他方面的影响的叙述性综合报告(根据2001年医学研究所的定义,包括安全性,有效性,效率,及时性、及时性病人中心,和公平性)。
本综述纳入了73项研究。直接或间接改善产妇健康质量以及SSA发病率和死亡率结局的非药物干预采取了多种形式,包括移动和电子健康,需求和供给方面的财政激励,基于设施的临床审核和孕产妇死亡审查,卫生系统加强干预措施,社区动员和/或基于同行的计划,以家庭为基础的访问,由医疗保健提供者进行的咨询和健康教育和促销计划,紧急产科护理的运输和/或通信和转诊,预防艾滋病毒母婴传播,和任务转移干预措施。有一个单一的设施和社区为基础的研究,其有效性很难评估的优势。
已经实施了许多非药物干预措施来改善SSA的孕产妇保健。这些干预措施主要是基于医疗机构和/或社区。虽然关于改善孕产妇健康的干预措施有效性的证据多种多样,研究结果强调了实施全面干预措施以加强医疗保健系统的不同组成部分的重要性,在社区和医疗机构,再加上支持性的政策环境。
PROSPEROCRD42015023750。
Many interventions have been implemented to improve maternal health outcomes in sub-Saharan Africa (SSA). Currently, however, systematic information on the effectiveness of these interventions remains scarce. We conducted a systematic
review of published evidence on non-drug interventions that reported effectiveness in improving outcomes and quality of care in maternal health in SSA.
African Journals Online, Bioline, MEDLINE, Ovid, Science Direct, and Scopus databases were searched for studies published in English between 2000 and 2015 and reporting on the effectiveness of interventions to improve quality and outcomes of maternal health care in SSA. Articles focusing on interventions that involved drug treatments, medications, or therapies were excluded. We present a narrative synthesis of the reported impact of these interventions on maternal morbidity and mortality outcomes as well as on other dimensions of the quality of maternal health care (as defined by the Institute of Medicine 2001 to comprise safety, effectiveness, efficiency, timeliness, patient centeredness, and equitability).
Seventy-three studies were included in this
review. Non-drug interventions that directly or indirectly improved quality of maternal health and morbidity and mortality outcomes in SSA assumed a variety of forms including mobile and electronic health, financial incentives on the demand and supply side, facility-based clinical audits and maternal death reviews, health systems strengthening interventions, community mobilization and/or peer-based programs, home-based visits, counseling and health educational and promotional programs conducted by health care providers, transportation and/or communication and referrals for emergency obstetric care, prevention of mother-to-child transmission of HIV, and task shifting interventions. There was a preponderance of single facility and community-based studies whose effectiveness was difficult to assess.
Many non-drug interventions have been implemented to improve maternal health care in SSA. These interventions have largely been health facility and/or community based. While the evidence on the effectiveness of interventions to improve maternal health is varied, study findings underscore the importance of implementing comprehensive interventions that strengthen different components of the health care systems, both in the community and at the health facilities, coupled with a supportive policy environment.
PROSPERO CRD42015023750.