School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
BMJ. 2011 Dec 1;343:d7102. doi: 10.1136/bmj.d7102.
To assess the effectiveness of strategies incorporating training and support of traditional birth attendants on the outcomes of perinatal, neonatal, and maternal death in developing countries.
Systematic review with meta-analysis.
Medline, Embase, the Allied and Complementary Medicine database, British Nursing Index, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, BioMed Central, PsycINFO, Latin American and Caribbean Health Sciences Literature database, African Index Medicus, Web of Science, Reproductive Health Library, and Science Citation Index (from inception to April 2011), without language restrictions. Search terms were "birth attend*", "traditional midwife", "lay birth attendant", "dais", and "comadronas". Review methods We selected randomised and non-randomised controlled studies with outcomes of perinatal, neonatal, and maternal mortality. Two independent reviewers undertook data extraction. We pooled relative risks separately for the randomised and non-randomised controlled studies, using a random effects model.
We identified six cluster randomised controlled trials (n=138 549) and seven non-randomised controlled studies (n=72 225) that investigated strategies incorporating training and support of traditional birth attendants. All six randomised controlled trials found a reduction in adverse perinatal outcomes; our meta-analysis showed significant reductions in perinatal death (relative risk 0.76, 95% confidence interval 0.64 to 0.88, P<0.001; number needed to treat 35, 24 to 70) and neonatal death (0.79, 0.69 to 0.88, P<0.001; 98, 66 to 170). Meta-analysis of the non-randomised studies also showed a significant reduction in perinatal mortality (0.70, 0.57 to 0.84, p<0.001; 48, 32 to 96) and neonatal mortality (0.61, 0.48 to 0.75, P<0.001; 96, 65 to 168). Six studies reported on maternal mortality and our meta-analysis showed a non-significant reduction (three randomised trials, relative risk 0.79, 0.53 to 1.05, P=0.12; three non-randomised studies, 0.80, 0.44 to 1.15, P=0.26).
Perinatal and neonatal deaths are significantly reduced with strategies incorporating training and support of traditional birth attendants.
评估培训和支持传统助产妇策略对发展中国家围产期、新生儿和产妇死亡结局的影响。
系统评价与荟萃分析。
Medline、Embase、辅助和补充医学数据库、英国护理索引、 Cochrane 图书馆、护理与联合健康文献累积索引、生物医学中心、PsycINFO、拉丁美洲和加勒比健康科学文献数据库、非洲医学索引、Web of Science、生殖健康图书馆和科学引文索引（从创刊到 2011 年 4 月），无语言限制。检索词为“birth attend*”、“traditional midwife”、“lay birth attendant”、“daɪs”和“comadronas”。
我们选择了随机和非随机对照试验，结局为围产期、新生儿和产妇死亡。两位独立的评审员进行了数据提取。我们使用随机效应模型分别对随机和非随机对照试验进行了相对风险的汇总。
我们确定了六项整群随机对照试验（n=138549）和七项非随机对照试验（n=72225），这些研究调查了培训和支持传统助产妇的策略。所有六项随机对照试验均发现不良围产期结局减少；我们的荟萃分析显示围产儿死亡显著减少（相对风险 0.76，95%置信区间 0.64 至 0.88，P<0.001；需要治疗的人数 35，24 至 70）和新生儿死亡（0.79，0.69 至 0.88，P<0.001；98，66 至 170）。非随机研究的荟萃分析也显示围产儿死亡率显著降低（0.70，0.57 至 0.84，P<0.001；48，32 至 96）和新生儿死亡率（0.61，0.48 至 0.75，P<0.001；96，65 至 168）。六项研究报告了产妇死亡率，我们的荟萃分析显示无显著减少（三项随机试验，相对风险 0.79，0.53 至 1.05，P=0.12；三项非随机试验，0.80，0.44 至 1.15，P=0.26）。
培训和支持传统助产妇的策略可显著降低围产期和新生儿死亡。
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