Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, 93106, CA, USA.
Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 630 West 168th Street, New York, 10032, NY, USA.
BMC Pregnancy Childbirth. 2020 May 24;20(1):316. doi: 10.1186/s12884-020-02992-y.
Pregnant women in sub-Saharan Africa tend to have low adherence to antenatal and postnatal care regimens, contributing to high infant and child mortality rates. Despite low adherence figures and the high returns from attending antenatal and postnatal care visits, research on interventions to improve adherence is in its infancy. Our aim was to determine the effectiveness of existing interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-Saharan Africa.
Full text, peer-reviewed articles, published in English and listed in PubMed or PsycINFO through January 2018 were identified in a systematic review. Studies were restricted to randomized controlled trials only and had to assess intervention impact on antenatal and postnatal care adherence, operationalized as the frequency of visits attended. Two reviewers independently screened papers for inclusion and evaluated the risk of systematic error in each study using the Cochrane risk of bias tool. Any discrepancies were reconciled by a third independent reviewer.
The initial search generated 186 articles, of which, five met our inclusion criteria. Due to the small sample size and methodological variation across studies, a pooled effect size estimate could not be obtained. Therefore, effects on antenatal and postnatal care adherence were examined and reported at the individual study level. None of the interventions were directly aimed at improving adherence, but two of the five, both behavioral interventions, demonstrated effectiveness in increasing antenatal care (rate ratio 5.86, 95% CI 2.6-13.0, p<0.0001) and postnatal care adherence (31.3%, 95% CI 15.4-47.2, p=0.0009), respectively. Three home visit interventions had no effect on antenatal care adherence. Although the risk of bias was unclear or high in some cases, it remained low in most categories across studies.
Results point to a large gap in the literature on interventions to address antenatal and postnatal care adherence in sub-Saharan Africa. Interventions drawing upon the executive function literature and the promising results of the behavioral interventions reviewed here are urgently needed to address these gaps.
The review was prospectively registered with PROSPERO, id number https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=88152, on February 7, 2018.
撒哈拉以南非洲的孕妇往往不太遵守产前和产后护理方案，这导致婴儿和儿童死亡率居高不下。尽管参与产前和产后护理就诊的比例较低，而且这种参与能带来很高的回报，但改善参与度的干预措施研究仍处于起步阶段。我们的目的是确定现有的干预措施在提高撒哈拉以南非洲孕妇遵守产前和产后护理方案方面的有效性。
我们通过系统评价，在 PubMed 或 PsycINFO 中检索了截至 2018 年 1 月发表的全文同行评审英文文献，以确定干预措施对提高撒哈拉以南非洲孕妇产前和产后护理参与度的有效性。研究仅限于随机对照试验，且必须评估干预措施对产前和产后护理参与度的影响，这通过就诊频率来衡量。两位评审员独立筛选纳入的文献，并使用 Cochrane 偏倚风险工具评估每项研究的系统误差风险。任何差异均由第三位独立评审员解决。
初步检索生成了 186 篇文章，其中 5 篇符合我们的纳入标准。由于样本量小且研究之间的方法学差异，无法得出汇总效应量估计值。因此，我们在个体研究层面上检查和报告了对产前和产后护理参与度的影响。没有一项干预措施直接旨在提高参与度，但其中两项（均为行为干预措施）分别证明了提高产前护理（率比 5.86，95%置信区间 2.6-13.0，p<0.0001）和产后护理参与度（31.3%，95%置信区间 15.4-47.2，p=0.0009）的有效性。三项家访干预措施对产前护理参与度没有影响。尽管某些情况下偏倚风险不明确或较高，但在大多数类别中，研究间的偏倚风险仍较低。
研究结果表明，撒哈拉以南非洲提高产前和产后护理参与度的干预措施文献存在较大差距。迫切需要借鉴执行功能文献和此处综述的行为干预措施的结果，来解决这些差距。
该综述于 2018 年 2 月 7 日在 PROSPERO（https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=88152）前瞻性注册。
