Community‐ based maternal and newborn interventions in Africa: Systematic review

• Published in: Journal of clinical nursing Vol. 30; no. 17-18; pp. 2514 - 2539
• Main Authors: Nishimwe, Clemence, Mchunu, Gugu G., Mukamusoni, Dariya
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-09-2021; John Wiley and Sons Inc
• Subjects: Africa; Africa South of the Sahara; Childbirth & labor; Community health care; Community Health Workers; Delivery of Health Care; Female; Health Promotion; Humans; Infant mortality; Infant, Newborn; Maternal & child health; maternal community health workers; Maternal Health Services; Maternal mortality; maternal/ newborn healthcare; Midwifery; Newborn babies; nurse/ midwifery primary health care; Perinatal care; Postpartum period; Pregnancy; Prenatal care; program planning and implementation; Review; Systematic review; Africa South of the Sahara; Africa; maternal/ newborn healthcare; systematic review; maternal community health workers; Africa; program planning and implementation; nurse/ midwifery primary health care
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/jocn.15737

Aim and objectives
This review analysed the implementation and integration into healthcare systems of maternal and newborn healthcare interventions in Africa that include community health workers to reduce maternal and newborn deaths.
Background
Most neonatal deaths (99%) occur in low‐ and middle‐income countries, with approximately half happening at home. In resource‐constrained settings, community‐based maternal and newborn care is regarded as a sound programme for improving newborn survival. Health workers can play an important role in supporting families to adopt sound health practices, encourage delivery in healthcare facilities and ensure timeous referral. Maternal and newborn mortality is a major public health problem, particularly in sub‐Saharan Africa, where the Millennium Development Goals 4, 5 and 6 were not achieved at the end of 2015.
Methods
The review includes quantitative, qualitative and mixed‐method studies, with a data‐based convergent synthesis design being used, and the results grouped into categories and trends. The review took into account the participants, interventions, context and outcome frameworks (PICO), and followed the adapted PRISMA format for reporting systematic reviews of the qualitative and quantitative evidence guide checklist.
Results
The results from the 17 included studies focused on three themes: antenatal, delivery and postnatal care interventions as a continuum. The main components of the interventions were inadequate, highlighting the need for improved planning before each stage of implementation. A conceptual framework of planning and implementation was elaborated to improve maternal and newborn health.
Conclusion
The systematic review highlight the importance of thoroughly planning before any programme implementation, and ensuring that measures are in place to enable continuity of services.
Relevant to the clinical practice
Conceptual framework of planning and implementation of maternal and newborn healthcare interventions by maternal community health workers.