The Effectiveness of Emergency Obstetric Referral Interventions in Developing Country Settings: A Systematic Review

摘要: Background Pregnancy complications can be unpredictable and many women in developing countries cannot access health facilities where life-saving care is available. This study assesses the effects of referral interventions that enable pregnant to reach during an emergency, after decision seek made. Methods findings Selected bibliographic databases were searched with no date or language restrictions. Randomised controlled trials quasi experimental designs a comparison group included. Outcomes interest included maternal neonatal mortality other intermediate measures such as service utilisation. Two reviewers independently selected, appraised, extracted articles using predefined fields. Forest plots, tables, qualitative summaries quality, size, direction effect used for analysis. Nineteen studies In South Asian settings, four organisational communities generated funds transport reduced deaths, largest seen India (odds ratio 0·48 95% CI 0·34–0·68). Three from sub-Saharan Africa reported reductions stillbirths maternity waiting home interventions, one statistically significant result (OR 0.56 0.32–0.96). Effects on unclear. Referral usually improved utilisation services but opposite was also documented. The multiple could not disentangled. Explanatory mechanisms through which worked ascertained. Conclusions Community mobilisation may reduce contribution components ascertained. reduction stillbirth rates resulting homes needs further study. have unexpected adverse effects. To inform implementation effective monitoring evaluation practices are necessary, along develop better understanding how work. Please see later article Editors' Summary