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Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh

BACKGROUND: Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates...

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Autores principales: Rahman, Anisur, Moran, Allisyn, Pervin, Jesmin, Rahman, Aminur, Rahman, Monjur, Yeasmin, Sharifa, Begum, Hosneara, Rashid, Harunor, Yunus, Mohammad, Hruschka, Daniel, Arifeen, Shams E, Streatfield, Peter K, Sibley, Lynn, Bhuiya, Abbas, Koblinsky, Marge
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257323/
https://www.ncbi.nlm.nih.gov/pubmed/22151276
http://dx.doi.org/10.1186/1471-2458-11-914
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author Rahman, Anisur
Moran, Allisyn
Pervin, Jesmin
Rahman, Aminur
Rahman, Monjur
Yeasmin, Sharifa
Begum, Hosneara
Rashid, Harunor
Yunus, Mohammad
Hruschka, Daniel
Arifeen, Shams E
Streatfield, Peter K
Sibley, Lynn
Bhuiya, Abbas
Koblinsky, Marge
author_facet Rahman, Anisur
Moran, Allisyn
Pervin, Jesmin
Rahman, Aminur
Rahman, Monjur
Yeasmin, Sharifa
Begum, Hosneara
Rashid, Harunor
Yunus, Mohammad
Hruschka, Daniel
Arifeen, Shams E
Streatfield, Peter K
Sibley, Lynn
Bhuiya, Abbas
Koblinsky, Marge
author_sort Rahman, Anisur
collection PubMed
description BACKGROUND: Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. METHODS: This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. RESULTS: Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018). CONCLUSION: The continuum of care approach provided through the integration of service delivery modes decreased the perinatal mortality rate within a short period of time. Further testing of this model is warranted within the government health system in Bangladesh and other low-income countries.
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spelling pubmed-32573232012-01-13 Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh Rahman, Anisur Moran, Allisyn Pervin, Jesmin Rahman, Aminur Rahman, Monjur Yeasmin, Sharifa Begum, Hosneara Rashid, Harunor Yunus, Mohammad Hruschka, Daniel Arifeen, Shams E Streatfield, Peter K Sibley, Lynn Bhuiya, Abbas Koblinsky, Marge BMC Public Health Research Article BACKGROUND: Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. METHODS: This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. RESULTS: Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018). CONCLUSION: The continuum of care approach provided through the integration of service delivery modes decreased the perinatal mortality rate within a short period of time. Further testing of this model is warranted within the government health system in Bangladesh and other low-income countries. BioMed Central 2011-12-10 /pmc/articles/PMC3257323/ /pubmed/22151276 http://dx.doi.org/10.1186/1471-2458-11-914 Text en Copyright ©2011 Rahman et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Rahman, Anisur
Moran, Allisyn
Pervin, Jesmin
Rahman, Aminur
Rahman, Monjur
Yeasmin, Sharifa
Begum, Hosneara
Rashid, Harunor
Yunus, Mohammad
Hruschka, Daniel
Arifeen, Shams E
Streatfield, Peter K
Sibley, Lynn
Bhuiya, Abbas
Koblinsky, Marge
Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh
title Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh
title_full Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh
title_fullStr Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh
title_full_unstemmed Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh
title_short Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh
title_sort effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from matlab, bangladesh
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257323/
https://www.ncbi.nlm.nih.gov/pubmed/22151276
http://dx.doi.org/10.1186/1471-2458-11-914
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