Background
Community level characteristics
Outreach services and home visitation
Task shifting
Human resource training
Community mobilization and support groups
Methods
Findings
Outreach Services
Reviews (n=16) | Description of included interventions | Type of studies included (no) | Targeted health care providers | Outcome reported | Pooled data (Y/N) | Results | |
---|---|---|---|---|---|---|---|
Other outcomes
|
MNCH specific outcomes
| ||||||
Blondel 1995[29] | Two different types of home visits during pregnancy: (1) those offering social support to high-risk women; and (2) those providing medical care to women with complications. | RCT’s: 08 | Nurses, family workers, midwives in HIC | Preterm delivery | Yes | 1.0 (0.8-1.1) | |
Hospital admission with complications | 0.9 (0.7-1.2) | ||||||
Bull 2004 (Overview)[45] | Home visiting is not a single or uniform intervention – it is a mechanism for the delivery of a variety of interventions directed at different outcomes. They may provide parent training/education, pyscho-social support to parents, infant stimulation, and infant and maternal health surveillance | Reviews: 09 | Nurses, midwives or lay people within different professional bases in HIC | Pregnancy outcome | No | No impact | |
Immunization rate | No impact | ||||||
Hospital admission | No impact | ||||||
Child injury | Positive impact | ||||||
Post natal depression | Positive impact | ||||||
Ciliska 2001[30] | Public health nursing interventions when carried out by the strategy of home visiting of clients in the pre- and postnatal period | 20 studies RCT's: 8 CCT: 3 analytic cohort: 1 | Nurses or midwives in HIC | Children’s mental development, mental health and physical growth, mother’s depression, maternal employment, education, nutrition and other health habits, and government cost saving. | No | No negative impacts reported in 12 strong articles | |
Children mental and physical health improved | |||||||
No impacts on LBW, gestational age and neonatal morbidity and mortality | |||||||
Elkan 2000[31] | Home visiting program with at least one postnatal visit | 102 papers with 86 home visiting programs | Nurses or midwives in HIC | Mental development score | Yes | 0.17 (0.06-0.28) | |
Motor development score | 0.17(–0.03-0.38) | ||||||
IQ | 0.32 (0.146-0.48) | ||||||
Weight | 0.04 (–0.17-2.46) | ||||||
Height | 0.04 ( –0.17-2.5) | ||||||
Immunization rate | 1.40 (1.16-1.68) | ||||||
Use of acute care | 0.73 (0.55-0.98) | ||||||
Hospital stay | 1.63 (1.18-2.24) | ||||||
ER | 0.77 (0.58-1.03) | ||||||
Gogia 2010[32] | Implementation by community health workers of safe delivery practices at home and proper care of the neonate immediately after birth, such as keeping the baby warm, providing neonatal resuscitation (if required) and initiating breastfeeding early. | RCT: 05 | CHW in LIC | ANC visit >1 | Yes | 1.33 (1.20-1.47) | |
Tetanus Toxoid (2 doses) | 1.11 (1.04-1.18) | ||||||
Skilled care at birth | 1.54 (0.81 - 2.93) | ||||||
Breastfeeding within 1 hour | 3.35 (1.31-8.59) | ||||||
Clean cord care | 1.70 (1.39-2.07) | ||||||
Delayed bathing | 4.63 (2.29-9.37) | ||||||
Neonatal mortality | 0.62 (0.44-0.87) | ||||||
Infant mortality | 0.41 (0.30–0.57) | ||||||
Neonatal cause-specific mortality due to:
| |||||||
Sepsis | 89.8% (78.6–101.0) | ||||||
Asphyxia | 53.3% (23.8–82.8) | ||||||
Prematurity | 38% (4.3–71.6) | ||||||
Hypothermia | 100% (one-sided 95% CI not stated) | ||||||
Gruen 2003[33] | Specialist outreach clinics: defined as planned and regular visits by specialist-trained medical practitioners from a usual practice location (hospital or specialist center) to primary care or rural hospital settings. | RCT: 05 CBA: 02 ITS: 02 | Primary healthcare practitioners and specialists | Adherence to treatment | Yes | 0.63 (0.52-0.77) | |
Patient and provider satisfaction | 0.43 (0.29-0.62) | ||||||
Use of service | 0.14 (0.05-0.32) | ||||||
Hodnett 2000[34] | Standardized or individualized programs of additional social support provided in either home visits, during regular antenatal clinic visits, and/or by telephone on several occasions during pregnancy. | RCT: 17 | Multidisciplinary teams of health professionals specially trained lay workers, or combination of lay and professional workers. | Caesarean birth | 0.87 (0.78-0.97) | ||
Gestational age less than 37 weeks at birth | 0.92 (0.83-1.01) | ||||||
Birth weight less than 2500 gm | 0.92 (0.83-1.03) | ||||||
Stillbirth/neonatal death | 0.96 (0.74-1.26) | ||||||
Antenatal hospital admission | 0.79 (0.68-0.92) | ||||||
Postnatal re-hospitalization | 1.60 (0.80-3.21) | ||||||
Antenatal depression | 0.77 (0.50, 1.19) | ||||||
Postnatal depression | 0.85 (0.69-1.05) | ||||||
Less than highly satisfied with antenatal care | 1.13 (0.76, 1.67) | ||||||
Hussein 2012[35] | Interventions included aimed to overcome delays in reaching the appropriate facility, which improved emergency referrals antenatally, during labour, or up to 42 d after delivery. | Total: 19 RCT: 04,controlled before after: 05,Cohort: 05 | Community groups and TBA | Neonatal mortality | No | 0.48 (0.34-0.68) | |
Stillbirths | 0.56 (0.32-0.96) | ||||||
Hussein 2012[36] | Refer pregnant and post-partum women suffering from an emergency obstetric complication or from home to basic-level health facilities (health centres) and from health centre to hospital (but not referral between hospitals) in LMIC | Total: 19 RCT: 04,controlled before after: 05,Cohort: 05 | Community groups and TBA | Neonatal mortality | No | 0.48 (0.34-0.68) | |
Stillbirths | 0.56 (0.32-0.96) | ||||||
Issel 2011[37] | Prenatal home visiting was defined as a nonmedical program or service focused on facilitating utilization of health or social services, provided in the home to pregnant women who were at high medical or social risk for adverse birth outcomes. | Total : 28 RCT: 14, descriptive: 2, retro cohort: 07, prospect cohort: 02, matched CC: 01, ecological : 01, static group: 01 | Home visiting personnel not defined | PNC utilization | No | 5/5 studies found significant improvement | |
Gestational age | 5/24 found a significant positive effect | ||||||
Birth weight | 7/17 found a significant positive effect | ||||||
Kandrick 2000[38] | The home visitation program had to include at least one post natal home visits | 11 RCT’s (9 meta-analyzed) | Nurses and midwives in HIC | Immunization uptake | Yes | 1.17 (0.33-4.17) (Random) | |
1.67 (1.29-2.15) (fixed) | |||||||
Lassi 2010[39] | Intervention packages that included additional training of outreach workers in maternal care during pregnancy, delivery and in the postpartum period; and routine newborn care. | 18 cluster-randomized/quasi-randomized trials | outreach workers in LMIC | Maternal mortality | Yes | 0.77 (0.59-1.02) | |
Maternal morbidity | 0.75 (0.61-0.92) | ||||||
Neonatal mortality | 0.76 (0.68-0.84) | ||||||
Perinatal mortality | 0.80 (0.71-0.91) | ||||||
Referral | 1.4 (1.19-1.65) | ||||||
Early breast feeding | 1.94 (1.56-2.42) | ||||||
Lonkhuijzen 12 [44] | All types of facilities within easy reach of a medical facility that are designated for the lodging of pregnant women who await labour, with the purpose of the women being assisted by skilled attendants during delivery | None | Not applicable | Not applicable | |||
McNaughton 2004[40] | Home-visiting interventions using professional nurses as home visitors. | 13 reports | Nurses in HIC | Maternal newborn health status | No | Narrative (more than half of the studies were able to achieve their desired results) | |
Peacock 2013[43] | Effect of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families. | 21 studies | Paraprofessional home-visiting staff | Child abuse and neglect | No | 3 out of 6 studies showed better outcomes | |
Physical growth | 5 out of 7 studies showed no significant improvement | ||||||
Hospitalization, illness and injuries | 2 out of 6 studies showed better health outcomes | ||||||
Up-to date immunizations | 1 study showed intervention group more likely to receive primary immunizations | ||||||
Pyone 2012[41] | Distance and transport cost related interventions | 5 studies | Community | MMR (associated with distance) | No | 7.4 (1.6 – 132.4) | |
Vieira 2012[42] | Interventions to increase birth with skilled health personnel, in settings where TBAs were providers of childbirth care | 6 observational studies | Skilled birth attendant | Obstetric mortality ratio | No | Deploying skilled health personnel and addressing financial barriers for users increased the use of skilled health personnel at birth | |
Decrease in maternal deaths | |||||||
Birth by a physician | |||||||
Birth by C-Section | |||||||
Increase in skilled birth attendance |
Task shifting
Reviews (n=06) | Description of included interventions | Type of studies included (no) | Targeted health care providers | Outcome reported | Pooled data (Y/N) | Results | |
---|---|---|---|---|---|---|---|
Other outcomes
|
MNCH specific outcomes
| ||||||
Bhutta 2012[71] | Mid-level healthcare provider defined as those who have received less training than doctors but who perform aspects of doctors’ tasks. | RCT/cRCT: 52 ITS: 02 Case Control:01 Before After: 01 | Nurse, midwives, auxillary nurse, auxillary nurse midwife, surgical technicians in both HIC and LMIC |
Wives versus doctors + midwives:
| Yes | ||
Rate of performing c- section | 0.92 (0.81-1.15) | ||||||
Postpartum hemorrhage | 1.03 (0.82-1.29) | ||||||
Overall fetal or neonatal deaths | 0.95 (0.69-1.30) | ||||||
Preterm births | 0.87 (0.73-1.04) | ||||||
Admission to neonatal intensive care | 1.03 (0.77-1.38) | ||||||
The use of intrapartum regional analgesia | 0.88 (0.81-0.96) | ||||||
Episiotomies | 0.83 (0.77-0.90) | ||||||
Rates of abortion complication | 1.74 (0.82-3.70) | ||||||
Adverse effects | 1.15 (0.84-1.56) | ||||||
Nurses versus doctors:
| |||||||
Repeat consultation | 0.90 (0.35-2.32) | ||||||
Better physical function | 1.06 (0.97-1.15) | ||||||
Attendance to follow-up visit | 1.26 (0.95-1.67) | ||||||
Attendance at emergency after receiving care | 1.02 (0.87-1.14) | ||||||
Satisfaction with the care received by nurses | 0.20 (0.14-0.26) | ||||||
Hatem 2008[47] | In midwife-led care, the midwife is the woman’s lead professional, but one or more consultations with medical staff are often part of routine practice. | RCT’s: 11 | HIC | Antenatal hospitalization | 0.90 (0.81-0.99) | ||
Regional analgesia | 0.81 (0.73-0.91) | ||||||
Episiotomy | 0.82 (0.77-0.88) | ||||||
Instrumental delivery | 0.86 (0.78-0.96) | ||||||
Intra-partum analgesia/anesthesia | 1.16 (1.05-1.29) | ||||||
SVD | 1.04 (1.02-1.06) | ||||||
Feeling in control during child birth | 1.74 (1.32- 2.30) | ||||||
Birth attended by midwife | 7.84 (4.15-14.81) | ||||||
Initiate breast feeding | 1.35 (1.03-1.76) | ||||||
Cesarean births | 0.96 (0.87-1.06) | ||||||
Fetal loss before 24 weeks | 0.79 (0.65-0.97) | ||||||
Fetal loss/ neonatal death at least 24 weeks | 1.01 (0.67-1.53) | ||||||
Fetal / neonatal death | 0.83 (0.70-1.00) | ||||||
Hospital stay | -2.00 (-2.15- -1.85) | ||||||
Laurant 2004[48] | Focus was on nurses working as substitutes for primary care doctors. Supplementation refers to the situation where a nurse supplements the care of the doctor by providing a new primary care service | RCT/Quasi: 13 Before After: 13 | Doctors and nurses in HIC |
Nurse versus doctors
| Yes | ||
Patient satisfaction | 0.28 (0.21-0.34) favors nurses | ||||||
Patient recall | 1.34 (1.20-1.49) favors nurses | ||||||
Prescribing rates | 1.00 (0.96-1.05) | ||||||
Referral rates | 0.79 (0.58-1.07) | ||||||
Lewin 2010[49] | Any intervention delivered by LHWs and intended to improve maternal or child health (MCH) or the management of infectious diseases. | RCT: 82 | LHW’s majority in LMIC | Immunization uptake | 1.22 (1.10-1.37) | ||
Initiation of breastfeeding | 1.36 (1.14 - 1.61) | ||||||
Any breastfeeding | 1.24 (1.10-1.39) | ||||||
Exclusive breastfeeding | 2.78 (1.74- 4.44) | ||||||
TB cure rates | 1.22 (1.13 - 1.31) | ||||||
TB preventive treatment completion | 1.00 (0.92 - 1.09) | ||||||
Child morbidity | 0.86 (0.75-0.99) | ||||||
Child mortality | 0.75 (0.55-1.03) | ||||||
Neonatal mortality | 0.76 (0.57-1.02) | ||||||
Care seeking for childhood illness | 1.33 (0.86-2.05) | ||||||
Pyone 2012[41] | Training of GP’s and assistants o perform caesarean sections | Studies: 03 | Assistant medical officers, GP | Maternal health outcomes, staff retention | No | Narrative | |
Thompson 2003[50] | Interventions included dietary advice given by a dietician or a nutritionist compared with another health professional (e.g. doctor or nurse) or self-help resources. | RCT’s: 12 | Dietitians , health professionals, nurses, doctors in HIC |
Dieticians vs. Dr.
| Yes | -0.25 mmol/L (-0.37, -0.12) | |
Blood Cholesterol | Favors dietician | ||||||
Dietician vs. self help
| -0.10 mmol/L (-0.22, 0.03) | ||||||
Blood cholesterol | |||||||
Dietician vs. nurses
| -0.06 mmol/L (-0.11, -0.01) | ||||||
HDLc | Favors dietician | ||||||
Dietician vs. counselor
| -5.80 (-8.91, -2.69) | ||||||
Body weight | Favors dietician | ||||||
Vieira 2012[42] | Included studies where Traditional Birth Attendants had been attending births prior to the intervention; and a transition to skilled health personnel were in progress or planned. The intervention was an increase in birth rate with skilled health professionals | 6 studies | Skilled health personnel | Obstetric mortality ratio | OR: 0.35 (95% CI 0.13-0.93) | ||
Decrease in maternal deaths | OR: 0.31 (95% CI 0.11-0.81) | ||||||
Birth by a physician | Increased with ranges from 22.4% to 70.2% | ||||||
Birth by C-Section | 1.67 times more likely |
Training of human resources
Reviews (n=18) | Description of included interventions | Type of studies included (no) | Targeted health care providers | Outcome reported | Pooled data (Y/N) | Results | |
---|---|---|---|---|---|---|---|
Other outcomes | MNCH specific outcomes | ||||||
Bhutta 2010[51] | In-service training to health personnel only, defined as SBAs (nurses, midwives, doctors or health personnel with midwifery skills) for better maternal outcomes. | Before after:08, Quais:02, Cross-sectional: 2 | Skilled birth attendants (doctors, nurses and midwives) as well as to other service providers (lab tech) in LMIC | Cesarean section | No | 1.78 (0.34-9.32) | |
Maternal mortality | 0.57 (0.36-0.91) | ||||||
Obstetric complications | 1.72 (0.72-4.10) | ||||||
Institutional delivery | 2.92 (2.09-4.06) | ||||||
Referrals | 0.57 (0.25-1.31) | ||||||
Mean antenatal visits | 0.90 (0.47-1.33) | ||||||
Giguere 2012[72] | The distribution of published or printed recommendations for clinical care and evidence to inform practice, including clinical practice guidelines, journals and monographs. | 14 RCTs 31 ITS | All health care professionals |
PEM vs. no intervention
| Yes | ||
Practice outcomes: (categorical) | Median absolute risk difference 0.02 (range 0, 0.11) i.e. 2% absolute improvement | ||||||
Profession practice outcomes: (continuous) | median improvement in standardised mean difference 0.13 (range -0.16, 0.36) | ||||||
Forsetlund 2009[53] | We included the following types of educational meetings: conferences, lectures, workshops, seminars, symposia, and courses. | Trials: 81 | Qualified health professionals or health professionals in postgraduate training mostly in HIC |
Any intervention with educational meeting vs. no intervention:
| Yes | 6% (1.8-15.9) | |
Compliance | |||||||
Only educational meeting vs. no intervention:
| |||||||
Compliance | 6% (2.9-15.3) | ||||||
Achievement of treatment goal | 3 (0.1-4) | ||||||
Hulscher 2005[54] | Within the professional oriented interventions we distinguished between conceptually different interventions: information transfer, learning through social influence, feedback and reminders. | RCT: 37 Quasi: 18 | Family physicians, general internists, gynaecologists, obstetricians, pediatricians and sometimesother professionals like nurse practitioners and radiologists in HIC |
Preventive services:
| |||
Group education vs. no intervention | Range: -4% - 31% | ||||||
Multifaceted interventions versus group education | Range: -31% - 28% | ||||||
Hyde 2000[55] | Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results and relevance to an individual’s work. | RCT:01 NRCT: 08 CBA: 07 | Doctors, midwives, managers and researchers | Knowledge | Yes | 0.10 (0.06-0.14) | |
Skills | 14/16 comparisons showed positive effect | ||||||
Attitude | 4/4 comparisons showed positive impact | ||||||
Lassi 2010[39] | Intervention packages that included additional training of outreach workers namely, female health workers/visitors, community midwives, community/village health workers, facilitators or TBAs in maternal care during pregnancy, delivery and in the postpartum period; and routine newborn care. | 18 cluster-randomized/quasi-randomized trials | Outreach workers namely, female health workers/visitors, community midwives, community/village health workers, facilitators or TBAs in LMIC | Maternal mortality | Yes | 0.77 (0.59-1.02) | |
Maternal morbidity | 0.75 (0.61-0.92) | ||||||
Neonatal mortality | 0.76 (0.68-0.84) | ||||||
Perinatal mortality | 0.80 (0.71-0.91) | ||||||
Referral | 1.4 (1.19-1.65) | ||||||
Early breast feeding | 1.94 (1.56-2.42) | ||||||
Légaré 2010[56] | Interventions may include but are not limited to the distribution of printed educational material, educational meetings, audit and feedback, reminders, and patient-mediated interventions | RCT’s:05 | Healthcare professionals, residents, fellows, and other pre licensurehealthcare professional |
Adoption of shared decision making:
| No | ||
Both patient mediated interventions | 1.06 (0.62-1.5) | ||||||
Multifaceted intervention vs usual care | 2.11 (1.3-2.9) | ||||||
Lugtenberg 2008[57] | CPGs were defined as ‘‘systematically developed statements to assist practitioner decisions about appropriate healthcare for specific clinical circumstances.’’ | cRCT: 10, before after: 10, ITS: 1 | Physicians | Process outcomes | No | 17/19 studies showed significant improvements | |
Patient outcomes | 6/9 studies showed significant but small improvements | ||||||
Norman 1998[58] | The conscientious explicit and judicious use of current evidence in making decisions about the care of individual patients | RCT: 03 CT:06 Cohort: 01 | Medical students, residents |
Undergraduate knowledge
| No | Mean gain 17.0%; [SD] 4.0%). | |
Residents knowledge | Mean gain 1.3%; SD 1.7%). | ||||||
O’Brien 2007[59] | Educational outreach visits, defined as use of a trained person from outside the practice setting who meets with healthcare professionals in their practice settings to provide information with the intent of changing their performance. | RCT: 69 | Healthcare professionals | Compliance | Yes | 5.6% (3.0-9.0%) | |
Prescribing | 4.8% (3.0-6.5%) | ||||||
Professional Performance | 6.0% (3.6-(16.0) | ||||||
Opiyo 2010[60] | Following in-service training courses aimed at changing provider behavior in the care of the seriously ill newborn or child: Neonatal and pediatric life support courses e.g. NLS, NRP, PALS, PLS, and others. Life support elements. Other in-service newborn and child health training courses aimed at the recognition and management of the seriously ill child | RCT: 02 | Doctors (general practitioners and specialists), nurses, pharmacists and dieticians/nutritionists, in outpatient or hospital-based settings in LMIC | Performance of adequate initial resuscitation steps | No | 2.45 (1.75-3.42) | |
Frequency of inappropriate and potentially harmful practices | 0.40 (0.13-0.66) | ||||||
Oxman 1995[61] | Participation of health care providers in conferences, lectures, workshops or traineeships outside their practice settings. | Trials: 17 | General healthcare providers | Change in health outcome and performance | No | Narrative | |
Reeves 2008[62] | An IPE intervention occurs when members of more than one health and/or social care profession learn interactively together, for the explicit purpose of improving inter-professional collaboration and/or the health/well being of patients/clients. | RCT: 04 CBA: 02 | Health and social care professionals | Patient satisfaction | No | 4/6 reported positive outcomes | |
Collaborative team behavior | |||||||
Reduction in clinical error | |||||||
Sibley 2012[73] | Trained birth attendants training | RCT: 6 | Trained birth attendants |
Trained birth attendants versus untrained birth attendants:
| No |
Adjusted OR (95% CI)
| |
Still births | 0.69 (0.57 to 0.83) | ||||||
Perinatal death | 0.70 (0.59 to 0.83) | ||||||
Maternal mortality | 0.74 (0.45 to 1.22) | ||||||
Referral | 1.50 (1.18 to 1.90) | ||||||
Neonatal deaths | 0.71 (0.61 to 0.82) | ||||||
Obstructed labor | 1.26 (1.03 to 1.54) | ||||||
Hemorrhage | 0.61 (0.47 to 0.79) | ||||||
Puerperal Sepsis | 0.17 (0.13 to 0.23) | ||||||
Smits 2002[63] | Educational intervention was problem based learning | RCT’s: 06 | Post graduate continuing education in HIC | Participant’s knowledge, performance, satisfaction | No | Narrative | |
Patients health | |||||||
Follow-up | |||||||
Thomas 1999[64] | Effect of clinical guideline on behavior of nurses, midwives or PAM's, on patient outcomes | RCT: 13 CBA: 2 ITS: 03 | Nursing, midwifery, health visiting, podiatry, speech and language therapy, physiotherapy and occupational therapy, pharmacy and radiography | General effectiveness | No | Narrative | |
Wensing 1998[65] | Information transfer through group education, reading material and patient education | RCT: 39 CBA: 22 | Physicians in HIC | Effectiveness against the reported outcome measures | No | Narrative | |
Worral 1997[66] | Interventions to improve medical practice like dissemination strategies such as conferences or mailing | 13 trials | Physicians in HIC | Conditions studies | No | 5/13 studies showed statistically significant results |
Community mobilization
Reviews (n=02) | Description of included interventions | Type of studies included (no) | Targeted health care providers | Outcome reported | Pooled data (Y/N) | Results | |
---|---|---|---|---|---|---|---|
Other outcomes | MNCH specific outcomes | ||||||
Jepson 2000[67] | Formation of a committee of community representatives, promotion of the screening service, and implementation of an appointment system by the committee | RCT: 02 | All people eligible to participate in a screening program as defined by the entry criteria for that program, included population groups such as pregnant women, neonates, children and adults in HIC | Mammogram uptake | No | Range: 5%-15% | |
Lassi 2010[39] | Intervention packages that included additional training of outreach workers namely, female health workers/visitors, community midwives, community/village health workers, facilitators or TBAs in maternal care during pregnancy, delivery and in the postpartum period; and routine newborn care. | 18 cluster-randomized/quasi-randomized trials | outreach workers namely, female health workers/visitors, community midwives, community/village health workers, facilitators or TBAs in LMIC | Maternal mortality | Yes | 0.77 (0.59-1.02) | |
Maternal morbidity | 0.75 (0.61-0.92) | ||||||
Neonatal mortality | 0.76 (0.68-0.84) | ||||||
Perinatal mortality | 0.80 (0.71-0.91) | ||||||
Referral | 1.4 (1.19-1.65) | ||||||
Early breast feeding | 1.94 (1.56-2.42) |