M Luck1. 1. Centro de Malária e Outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, P-1300 Lisboa, Portugal.
Abstract
OBJECTIVE: To review the findings of safe motherhood intervention studies conducted in African settings. DATA SOURCES: Published literature regarding interventions designed to reduce maternal mortality in African settings. STUDY SELECTION: Studies conducted in sub-Saharan Africa to assess the effects of interventions designed to reduce maternal mortality. DATA EXTRACTION: Search of Medline database for the years 1988 to 1998 with additional manual search of references cited in Medline-referenced studies. DATA SYNTHESIS: Few of the 34 intervention studies identified used a double-blind, randomized controlled trial design (4/34), or outcome measures directly related to maternal mortality or maternal health (7/34). Six of the studies produced reasonably convincing evidence of a positive effect on maternal health outcomes. Of these, three showed that changes in delivery practices brought about improved maternal outcomes, two found that a combined intervention consisting of upgrading of emergency obstetric services and community education increased the number of major obstetric complications treated, and one showed that a range of improvements in hospital equipment and management reduced facility-based maternal mortality ratios. No study sought to reduce maternal mortality associated with unsafe termination of pregnancy. CONCLUSIONS: More than a decade after the launching of the Safe Motherhood Initiative, there exists little evidence regarding which interventions will reduce maternal mortality levels in African settings. Intervention studies conducted in Africa have identified several low-tech improvements in emergency obstetric services which improve maternal outcomes and deserve replication and testing in a variety of settings. Further operational research should be conducted to identify and test other promising safe motherhood interventions, in particular interventions designed to reduce the important proportion of maternal mortality associated with unsafe termination of pregnancy.
OBJECTIVE: To review the findings of safe motherhood intervention studies conducted in African settings. DATA SOURCES: Published literature regarding interventions designed to reduce maternal mortality in African settings. STUDY SELECTION: Studies conducted in sub-Saharan Africa to assess the effects of interventions designed to reduce maternal mortality. DATA EXTRACTION: Search of Medline database for the years 1988 to 1998 with additional manual search of references cited in Medline-referenced studies. DATA SYNTHESIS: Few of the 34 intervention studies identified used a double-blind, randomized controlled trial design (4/34), or outcome measures directly related to maternal mortality or maternal health (7/34). Six of the studies produced reasonably convincing evidence of a positive effect on maternal health outcomes. Of these, three showed that changes in delivery practices brought about improved maternal outcomes, two found that a combined intervention consisting of upgrading of emergency obstetric services and community education increased the number of major obstetric complications treated, and one showed that a range of improvements in hospital equipment and management reduced facility-based maternal mortality ratios. No study sought to reduce maternal mortality associated with unsafe termination of pregnancy. CONCLUSIONS: More than a decade after the launching of the Safe Motherhood Initiative, there exists little evidence regarding which interventions will reduce maternal mortality levels in African settings. Intervention studies conducted in Africa have identified several low-tech improvements in emergency obstetric services which improve maternal outcomes and deserve replication and testing in a variety of settings. Further operational research should be conducted to identify and test other promising safe motherhood interventions, in particular interventions designed to reduce the important proportion of maternal mortality associated with unsafe termination of pregnancy.