This document reviews evidence for 21 antenatal care interventions that can be delivered to neglected populations in low-income countries. These interventions can be provided by non-professional health workers and do not require laboratory support. The review found that achieving high coverage of this set of interventions could substantially reduce maternal mortality, newborn mortality, stillbirths, prematurity, and intrauterine growth restriction. Certain interventions, like detecting and timely treating pre-eclampsia, could prevent up to a quarter of newborn and stillbirth deaths and over 90% of maternal deaths from pre-eclampsia. Other interventions are highly effective in specific settings, such as insecticide-treated bed nets reducing mortality risks by 10-20% in areas
This document reviews evidence for 21 antenatal care interventions that can be delivered to neglected populations in low-income countries. These interventions can be provided by non-professional health workers and do not require laboratory support. The review found that achieving high coverage of this set of interventions could substantially reduce maternal mortality, newborn mortality, stillbirths, prematurity, and intrauterine growth restriction. Certain interventions, like detecting and timely treating pre-eclampsia, could prevent up to a quarter of newborn and stillbirth deaths and over 90% of maternal deaths from pre-eclampsia. Other interventions are highly effective in specific settings, such as insecticide-treated bed nets reducing mortality risks by 10-20% in areas
This document reviews evidence for 21 antenatal care interventions that can be delivered to neglected populations in low-income countries. These interventions can be provided by non-professional health workers and do not require laboratory support. The review found that achieving high coverage of this set of interventions could substantially reduce maternal mortality, newborn mortality, stillbirths, prematurity, and intrauterine growth restriction. Certain interventions, like detecting and timely treating pre-eclampsia, could prevent up to a quarter of newborn and stillbirth deaths and over 90% of maternal deaths from pre-eclampsia. Other interventions are highly effective in specific settings, such as insecticide-treated bed nets reducing mortality risks by 10-20% in areas
BACKGROUND Although this is beginning to change, the content of antenatal care has been relatively neglected in safe-motherhood program efforts. This appears in part to be due to an unwarranted belief that interventions over this period have far less impact than those provided around the time of birth. In this par, we review available evidence for 21 interventions potentially deliverable during pregnancy at high coverage to neglected populations in low income countries, with regard to effectiveness in reducing risk of: maternal mortality, newborn mortality, stillbirth, prematurity and intrauterine growth restriction. Selection was restricted to interventions that can be provided by non-professional health auxiliaries and not requiring laboratory support. Method
In this narrative review, we included relevant
Cochrane and other systematic reviews and did comprehensive bibliographic searches. Inclusion criteria varied by intervention; where available randomized controlled trial evidence was insufficient, observational study evidence was considered. For each intervention we focused on overall contribution to our outcomes of interest, across varying epidemiologies. Results In the aggregate, achieving high effective coverage for this set of interventions would very substantially reduce risk for our outcomes of interest and reduce outcome inequities. Certain specific interventions, if pushed to high coverage have significant potential impact across many settings. For example, reliable detection of pre-eclampsia followed by timely delivery could prevent up to of newborn and stillbirth deaths and over 90% of maternal eclampsia/pre-eclampsia deaths. Other interventions have potent effects in specific settings: in areas of high P falciparum burden, systematic use of insecticide-treated nets and/or intermittent presumptive therapy in pregnancy could reduce maternal mortality by up to 10%, newborn mortality by up to 20%, and stillbirths by up to 2530%. Behavioral interventions targeting practices at birth and in the hours that follow can have substantial impact in settings where many births happen at home: in such circumstances early initiation of breastfeeding can reduce risk of newborn death by up to 20%; good thermal care practices can reduce mortality risk by a similar order of magnitude. Conclusions
Simple interventions delivered during pregnancy
have considerable potential impact on important mortality outcomes. More programmatic effort is warranted to ensure high effective coverage. THANK YOU!
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