Fragile and conflict-affected situations (FCS) in Asia and the Middle-East contribute significantly to global maternal and neonatal deaths. This systematic review explored maternal and neonatal health (MNH) services usage and determinants in FCS in Asia and the Middle-East to inform policy on health service provision in these challenging settings.
This systematic review was conducted using a standardised protocol. Pubmed, Embase, Web of Science, and selected development agency websites were searched for studies meeting inclusion criteria. Studies were assessed for methodological quality using an adapted evaluation tool. Qualitative and quantitative data were synthesized and pooled odds ratios generated for meta-analysis of service-usage determinants.
Of 18 eligible peer-reviewed studies, eight were from Nepal, four from Afghanistan, and two each from Iraq, Yemen, and the Palestinian Territories. Fragile situations provide limited evidence on emergency obstetric care, postnatal care, and newborn services. Usage of MNH services was low in all FCS, irrespective of economic growth level. Demand-side determinants of service-usage were transportation, female education, autonomy, health awareness, and ability-to-pay. Supply-side determinants included service availability and quality, existence of community health-workers, costs, and informal payments in health facilities. Evidence is particularly sparse on MNH in acute crises, and remains limited in fragile situations generally.
Findings emphasize that poor MNH status in FCS is a leading contributor to the burden of maternal and neonatal ill-health in Asia and the Middle-East. Essential services for skilled birth attendance and emergency obstetric, newborn, and postnatal care require improvement in FCS. FCS require additional resources and policy attention to address the barriers to appropriate MNH care. Authors discuss the ‘targeted policy approach for vulnerable groups’ as a means of addressing MNH service usage inequities.
Gruber J. Technical assistance for health in non-conflict fragile states: challenges and opportunities. Int J Health Plann Manage. 2009;24:4–20. CrossRef
Closing the gap in a generation: Health equity through action on the social determinants of health. Report. Geneva: WHO; 2012.
United Nations, “Post-MDG agenda”. 2012. http://www.who.int/topics/millennium_development_goals/post2015/summary_informal_consultation_memberstates_20121214.pdf. Accessed 25 Aug 2013.
Protecting Mothers in Risky Situations. UNFPA 2013. http://www.unfpa.org/emergencies/motherhood.htm. 2013. Accessed 25 Aug 2013.
Wang W, et al. Levels and trends in the use of maternal health services in developing countries. USAID Report 2011. USA.
The World Health Organization. 2014. http://www.who.int/mediacentre/factsheets/fs348/en/. Accessed 12 May 2014.
The World Health Organization. 2014. http://apps.who.int/gho/data/view.main.CM1300R?lang=en. Accessed 12 May 2014.
The World Health Organization. 2014. http://www.who.int/gho/countries/en/. Accessed 12 May 2014.
The World Health Organization. 2014. http://www.childinfo.org/maternal_mortality.html. Accessed 12 May 2014.
Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, et al. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med. 2011;8(8):e1001080. doi: 10.1371/journal.pmed.1001080.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analysis of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:W65–94. CrossRefPubMed
National Institute of Health Research. PROSPERO. International Register of Prospective Systematic Reviews. http://www.crd.york.ac.uk/PROSPERO/. Accessed 27 April 2014.
McGill University. Mixed Methods Appraisal Tool (MMAT) – Version 2011. USA. Accessed 1 March 2014.
Choulagai, et al. Barriers to using skilled birth attendants’ services in mid- and far-western Nepal: a cross-sectional study. BMC Int Health Hum Rights. 2013;13:49. http://www.biomedcentral.com/1472-698X/13/49. CrossRefPubMedPubMedCentral
Devkota, Bhatta. Newborn care practices of mothers in a rural community in Baitadi, Nepal. Health Prospect. 2011;10:5–9.
Karkee, et al. Determinants of facility delivery after implementation of safer mother programme in Nepal: a prospective cohort study. BMC Pregnancy Childbirth. 2013;13:193. http://www.biomedcentral.com/1471-2393/13/193. CrossRefPubMedPubMedCentral
Sharma, et al. Factors associated with place of delivery in rural Nepal. BMC Public Health. 2014;14:306. http://www.biomedcentral.com/1471-2458/14/306. CrossRefPubMedPubMedCentral
Shrestha, et al. Changing trends on the place of delivery: why do Nepali women give birth at home? Reprod Health. 2012;9:25. http://www.reproductive-health-journal.com/content/9/1/25. CrossRefPubMedPubMedCentral
Khorrami, et al. Maternal healthcare needs assessment survey at Rabia Balkhi Hospital in Kabul, Afghanistan. Int J Gynecol Obstet. 2008;101:259–63. CrossRef
Newbrander, et al. Barriers to appropriate care for mothers and infants during the perinatal period in rural Afghanistan: A qualitative assessment. Glob Public Health. doi: 10.1080/17441692.2013.827735.
Rahmani, Brekke. Antenatal and obstetric care in Afghanistan – a qualitative study among health care receivers and health care providers. BMC Health Serv Res. 2013;13:166. http://www.biomedcentral.com/1472-6963/13/166. CrossRefPubMedPubMedCentral
Najem, Al-Deen. Breast feeding problems in primipara mothers in early postnatal period. Iraqi J Comm Med. 2011;24(3).
Basaleem. Women’s reproductive health seeking behavior in four districts in Sana’a, Yemen: quantitative and qualitative analysis. J Community Med Health Educ. 2012;2:5. http://dx.doi.org/10.4172/2161-0711.1000153.
Unicef. Occupied Palestinian territory Mena gender equality profile status of girls and women in the Middle East and North Africa. 2011. Regional office for North Africa and Middle East.
World Health Organization. Inter-agency Field Manual on Reproductive Health in Humanitarian Settings. Report. 2010. http://www.who.int/reproductivehealth/publications/emergencies/field_manual_rh_humanitarian_settings.pdf. Accessed 15 July 2014.
World vision. Guide to maternal, newborn and child health and nutrition in emergencies. 2012. http://www.wvi.org/sites/default/files/MNCH%20in%20Emergencies%20Guide%20FINAL_1.pdf. Accessed 15 July 2014.
Choguya, et al. Traditional birth attendants and policy ambivalence in Zimbabwe. J Anthropol. 2014;2014:Article ID 750240. CrossRef
The World Health Organization. The African Regional Health Report. 2009.
Mann, et al. Post-partum mother and child care: a comparison of four African countries. Lancet. 2012;380.
Okuga M, et al. Glob Health Action. 2015;8:23968. http://dx.doi.org/10.3402/gha.v8.23968
Gopalan SS, Mutasa R, Friedman J, Das A. Health sector demand-side financial incentives in low- and middle-income countries: a systematic review on demand- and supply-side effects. Soc Sci Med. 2014;100:72e83. CrossRef
Datta D, Datta PP. Maternal mortality in India: problems and challenges. Asian J Med Res. 2013;2(1):33–5.
One world nations online. https://www.britannica.com/place/Middle-East and http://www.duhaime.org/LegalDictionary/M/MiddleEast.aspx. Accessed 27 Apr 2014.
The World Bank. 2014. Maternal & Reproductive Health Services. http://www.worldbank.org/en/topic/reproductivematernalchildhealth/brief/reproductive-health-and-the-world-bank-the-facts. Accessed 27 Apr 2014.
The World Bank. 2014. Accessed on 1 st March 2014. USA. http://siteresources.worldbank.org/EXTLICUS/Resources/511777-1269623894864/HarmonizedlistoffragilestatesFY14.pdf. Accessed 27 Apr 2014.
- Maternal and neonatal service usage and determinants in fragile and conflict-affected situations: a systematic review of Asia and the Middle-East
Saji S. Gopalan
- BioMed Central
Neu im Fachgebiet Gynäkologie und Geburtshilfe
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II