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Effective Linkages of Continuum of Care for Improving Neonatal, Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis

Author

Listed:
  • Kimiyo Kikuchi
  • Evelyn Korkor Ansah
  • Sumiyo Okawa
  • Yeetey Enuameh
  • Junko Yasuoka
  • Keiko Nanishi
  • Akira Shibanuma
  • Margaret Gyapong
  • Seth Owusu-Agyei
  • Abraham Rexford Oduro
  • Gloria Quansah Asare
  • Abraham Hodgson
  • Masamine Jimba
  • Ghana EMBRACE Implementation Research Project Team

Abstract

Background: Continuum of care has the potential to improve maternal, newborn, and child health (MNCH) by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood) and space dimensions (from community-family care to clinical care). However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries. Methods: We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers’ uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality. Results: Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I2 79%). Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I2 81%). Conclusions: Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The review was conclusive for the reduction of neonatal and perinatal deaths. Although maternal deaths were not significantly reduced, composite measures of all mortality were. Thus, the evidence is sufficient to scale up this intervention package for the improvement of MNCH outcomes.

Suggested Citation

  • Kimiyo Kikuchi & Evelyn Korkor Ansah & Sumiyo Okawa & Yeetey Enuameh & Junko Yasuoka & Keiko Nanishi & Akira Shibanuma & Margaret Gyapong & Seth Owusu-Agyei & Abraham Rexford Oduro & Gloria Quansah As, 2015. "Effective Linkages of Continuum of Care for Improving Neonatal, Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-27, September.
  • Handle: RePEc:plo:pone00:0139288
    DOI: 10.1371/journal.pone.0139288
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Neena Shah More & Ujwala Bapat & Sushmita Das & Glyn Alcock & Sarita Patil & Maya Porel & Leena Vaidya & Armida Fernandez & Wasundhara Joshi & David Osrin, 2012. "Community Mobilization in Mumbai Slums to Improve Perinatal Care and Outcomes: A Cluster Randomized Controlled Trial," Working Papers id:5098, eSocialSciences.
    3. Adjiwanou, Vissého & LeGrand, Thomas, 2013. "Does antenatal care matter in the use of skilled birth attendance in rural Africa: A multi-country analysis," Social Science & Medicine, Elsevier, vol. 86(C), pages 26-34.
    4. Magadi, Monica Akinyi & Madise, Nyovani Janet & Rodrigues, Roberto Nascimento, 2000. "Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities," Social Science & Medicine, Elsevier, vol. 51(4), pages 551-561, August.
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    Cited by:

    1. Kimiyo Kikuchi & Sumiyo Okawa & Collins O F Zamawe & Akira Shibanuma & Keiko Nanishi & Azusa Iwamoto & Yu Mon Saw & Masamine Jimba, 2016. "Effectiveness of Continuum of Care—Linking Pre-Pregnancy Care and Pregnancy Care to Improve Neonatal and Perinatal Mortality: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 11(10), pages 1-13, October.
    2. Usman, Mohd. & Banerjee, Adrita & Srivastava, Shobhit, 2021. "Association between maternal health continuum of care and child Survival: Evidence from a population based survey," Children and Youth Services Review, Elsevier, vol. 128(C).
    3. Ashrita Saran & Howard White & Kerry Albright & Jill Adona, 2020. "Mega‐map of systematic reviews and evidence and gap maps on the interventions to improve child well‐being in low‐ and middle‐income countries," Campbell Systematic Reviews, John Wiley & Sons, vol. 16(4), December.
    4. Abdulaziz Mohammed Hussen & Ibrahim Mohammed Ibrahim & Binyam Tilahun & Özge Tunçalp & Diederick E. Grobbee & Joyce L. Browne, 2023. "Completion of the Continuum of Maternity Care in the Emerging Regions of Ethiopia: Analysis of the 2019 Demographic and Health Survey," IJERPH, MDPI, vol. 20(13), pages 1-14, July.
    5. Sabrina Sharmin Priyanka & Dibbya Pravas Dasgupta & Abu Yousuf Md Abdullah & Nazia Binte Ali & Hafeza Khatun & Sk Masum Billah, 2024. "Assessing the Quality and Coverage of Maternal Postnatal Care in Bangladesh: A Comparative Analysis of Quality Postnatal Care among Home and Facility Births," IJERPH, MDPI, vol. 21(3), pages 1-15, March.

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