Center for Business, Health, and Prosperity, David Eccles School of Business, University of Utah, Salt Lake City, Utah, USA.
Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Glob Health Action. 2022 Dec 31;15(1):2058170. doi: 10.1080/16549716.2022.2058170.
Skilled attendance at birth is considered key to accomplishing Sustainable Development Goal (SDG) 3.1 aimed at reducing maternal mortality. Many maternal deaths can be prevented if a woman receives care by skilled health personnel. Maternal utilization of skilled health delivery services in rural areas in low- and middle-income countries is 70% compared to 90% in urban areas. Previous studies have found community-based interventions may increase rural maternal uptake of skilled health delivery services, but evidence is lacking on which strategies are most effective.
To review the effectiveness of community-based strategies to increase rural maternal utilization of skilled health personnel for childbirth delivery in low-and middle-income countries.
We conducted a narrative review. PubMed, CINAHL, Cochrane Library, and PsycINFO databases were searched for articles from database inception through 13 November 2019. Key search terms were pre-determined. Information was extracted on studies meeting our inclusion criteria: cluster and randomized trials, rural setting, reproductive aged women, community engagement, low- and middle-income countries. Studies were considered effective if statistically significant (p < 0.05). A narrative synthesis was conducted.
Ten cluster randomized trials out of 5,895 candidate citations met the inclusion criteria. Strategies included home-based visits, women's groups, and combined approaches. Out of the ten articles, only three studies were found to significantly increase maternal uptake of skilled health personnel for delivery, and each used a different strategy. The results are inconclusive as to which strategies are most effective. Limitations of this review include heterogeneity and generalizability of studies.
This research suggests that different strategies may be effective at improving maternal utilization of skilled health personnel for delivery in certain rural settings while ineffective in others. More research is warranted to better understand the context in which strategies may be effective and under what conditions.
熟练的接生人员被认为是实现可持续发展目标 3.1 的关键，该目标旨在降低产妇死亡率。如果妇女接受熟练的卫生人员的护理，许多产妇死亡是可以预防的。与城市地区 90%的利用率相比，农村地区中低收入国家的产妇对熟练卫生分娩服务的利用率为 70%。先前的研究发现，基于社区的干预措施可能会增加农村地区产妇对熟练卫生分娩服务的利用，但缺乏关于哪些策略最有效的证据。
综述基于社区的策略对增加中低收入国家农村地区产妇利用熟练卫生人员进行分娩的有效性。
我们进行了叙述性综述。在 2019 年 11 月 13 日之前，从数据库开始在 PubMed、CINAHL、Cochrane 图书馆和 PsycINFO 数据库中搜索符合我们纳入标准的文章：集群和随机试验、农村环境、育龄妇女、社区参与、中低收入国家。如果具有统计学意义（p<0.05），则认为研究是有效的。进行了叙述性综合。
在 5895 篇候选引文中有 10 篇符合纳入标准的集群随机试验。策略包括家访、妇女团体和综合方法。在这 10 篇文章中，只有 3 项研究发现显著增加了产妇对分娩时熟练卫生人员的利用，并且每个研究都使用了不同的策略。结果表明，哪种策略最有效尚无定论。本综述的局限性包括研究的异质性和普遍性。
这项研究表明，在某些农村环境中，不同的策略可能对改善产妇对熟练卫生人员的分娩利用有效，而在其他环境中则无效。需要进一步的研究来更好地了解策略可能有效的背景以及在什么条件下有效。
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