Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
APIN Clinic, Infectious Diseases Unit, Jos University Teaching Hospital, Jos, Plateau State, Nigeria.
BMJ Open. 2022 Feb 15;12(2):e054784. doi: 10.1136/bmjopen-2021-054784.
To systematically scope and map research regarding interventions, programmes or strategies to improve maternal and newborn health (MNH) in Nigeria.
Scoping review.
Systematic searches were conducted from 1 June to 22 July 2020 in PubMed, Embase, Scopus, together with a search of the grey literature. Publications presenting interventions and programmes to improve maternal or newborn health or both in Nigeria were included.
The data extracted included source and year of publication, geographical setting, study design, target population(s), type of intervention/programme, reported outcomes and any reported facilitators or barriers. Data analysis involved descriptive numerical summaries and qualitative content analysis. We summarised the evidence using a framework combining WHO recommendations for MNH, the continuum of care and the social determinants of health frameworks to identify gaps where further research and action may be needed.
A total of 80 publications were included in this review. Most interventions (71%) were aligned with WHO recommendations, and half (n=40) targeted the pregnancy and childbirth stages of the continuum of care. Most of the programmes (n=74) examined the intermediate social determinants of maternal health related to health system factors within health facilities, with only a few interventions aimed at structural social determinants. An integrated approach to implementation and funding constraints were among factors reported as facilitators and barriers, respectively.
Using an integrated framework, we found most MNH interventions in Nigeria were aligned with the WHO recommendations and focused on the intermediate social determinants of health within health facilities. We determined a paucity of research on interventions targeting the structural social determinants and community-based approaches, and limited attention to pre-pregnancy interventions. To accelerate progress towards the sustainable development goal MNH targets, greater focus on implementing interventions and measuring context-specific challenges beyond the health facility is required.
系统地概述和绘制有关干预措施、方案或策略的研究，以改善尼日利亚的母婴健康。
范围综述。
2020 年 6 月 1 日至 7 月 22 日，在 PubMed、Embase、Scopus 进行了系统搜索，并对灰色文献进行了搜索。纳入了旨在改善尼日利亚母婴或两者健康的干预措施和方案的出版物。
提取的数据包括来源和出版年份、地理环境、研究设计、目标人群、干预/方案类型、报告的结果以及任何报告的促进因素或障碍。数据分析包括描述性的数值摘要和定性内容分析。我们使用结合了世卫组织母婴健康建议、护理连续体和健康决定因素框架的框架总结证据，以确定需要进一步研究和行动的空白领域。
本综述共纳入 80 篇出版物。大多数干预措施（71%）与世卫组织的建议一致，其中一半（n=40）针对护理连续体的妊娠和分娩阶段。大多数方案（n=74）研究了与医疗机构内卫生系统因素有关的与产妇健康相关的中间社会决定因素，只有少数干预措施针对结构性社会决定因素。综合实施方法和资金限制是报告的促进因素和障碍因素。
使用综合框架，我们发现尼日利亚的大多数母婴健康干预措施都与世卫组织的建议一致，并且侧重于医疗机构内健康的中间社会决定因素。我们确定了针对结构性社会决定因素和基于社区的方法的干预措施研究不足，以及对孕前干预措施的关注有限。为了加速实现可持续发展目标母婴健康目标的进展，需要更加注重实施干预措施和衡量医疗机构以外的具体情况挑战。
