International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
PLoS One. 2013 Jun 20;8(6):e66453. doi: 10.1371/journal.pone.0066453. Print 2013.
Targeted interventions to improve maternal and child health is suggested as a feasible and sometimes even necessary strategy to reduce inequity. The objective of this systematic review was to gather the evidence of the effectiveness of targeted interventions to improve equity in MDG 4 and 5 outcomes.
We identified primary studies in all languages by searching nine health and social databases, including grey literature and dissertations. Studies evaluating the effect of an intervention tailored to address a structural determinant of inequity in maternal and child health were included. Thus general interventions targeting disadvantaged populations were excluded. Outcome measures were limited to indicators proposed for Millennium Development Goals 4 and 5. We identified 18 articles, whereof 15 evaluated various incentive programs, two evaluated a targeted policy intervention, and only one study evaluated an intervention addressing a cultural custom. Meta-analyses of the effectiveness of incentives programs showed a pooled effect size of RR 1.66 (95% CI 1.43-1.93) for antenatal care attendance (four studies with 2,476 participants) and RR 2.37 (95% CI 1.38-4.07) for health facility delivery (five studies with 25,625 participants). Meta-analyses were not performed for any of the other outcomes due to scarcity of studies.
The targeted interventions aiming to improve maternal and child health are mainly limited to addressing economic disparities through various incentive schemes like conditional cash transfers and voucher schemes. This is a feasible strategy to reduce inequity based on income. More innovative action-oriented research is needed to speed up progress in maternal and child survival among the most disadvantaged populations through interventions targeting the underlying structural determinants of inequity.
改善母婴健康的针对性干预措施被认为是减少不平等现象的一种可行策略，有时甚至是必要策略。本系统评价的目的是收集证据，以了解改善千年发展目标 4 和 5 成果的公平性的针对性干预措施的有效性。
我们使用 9 个卫生和社会数据库（包括灰色文献和学位论文）以所有语言搜索，确定了初步研究。我们纳入了评估针对母婴健康中不平等的结构性决定因素的干预措施效果的研究。因此，我们排除了针对弱势群体的一般性干预措施。我们将研究结果仅限于千年发展目标 4 和 5 提出的指标。我们确定了 18 篇文章，其中 15 篇评估了各种激励计划，2 篇评估了有针对性的政策干预，只有 1 篇评估了针对文化习俗的干预措施。激励计划效果的荟萃分析显示，产前护理参与率（4 项研究，2476 名参与者）的汇总效应大小为 RR 1.66（95%CI 1.43-1.93），医疗设施分娩率（5 项研究，25625 名参与者）的 RR 为 2.37（95%CI 1.38-4.07）。由于研究数量稀少，没有对任何其他结果进行荟萃分析。
旨在改善母婴健康的针对性干预措施主要局限于通过各种激励计划，如有条件现金转移和代金券计划，来解决经济差距问题。这是基于收入减少不平等的可行策略。需要更多创新的行动导向研究，通过针对不平等的潜在结构性决定因素的干预措施，加速最弱势群体母婴生存的进展。
