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A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal
BACKGROUND: Maternal and neonatal mortality rates remain high in many economically underdeveloped countries, including Nepal, and good quality antenatal care can reduce adverse pregnancy outcomes. However, identifying how to best improve antenatal care can be challenging. OBJECTIVE: To identify the...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883503/ https://www.ncbi.nlm.nih.gov/pubmed/35252905 http://dx.doi.org/10.1016/j.xagr.2021.100019 |
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author | Toolan, Miriam Barnard, Katie Lynch, Mary Maharjan, Nashna Thapa, Meena Rai, Nisha Lavender, Tina Larkin, Michael Caldwell, Deborah M. Burden, Christy Manandhar, Dharma S. Merriel, Abi |
author_facet | Toolan, Miriam Barnard, Katie Lynch, Mary Maharjan, Nashna Thapa, Meena Rai, Nisha Lavender, Tina Larkin, Michael Caldwell, Deborah M. Burden, Christy Manandhar, Dharma S. Merriel, Abi |
author_sort | Toolan, Miriam |
collection | PubMed |
description | BACKGROUND: Maternal and neonatal mortality rates remain high in many economically underdeveloped countries, including Nepal, and good quality antenatal care can reduce adverse pregnancy outcomes. However, identifying how to best improve antenatal care can be challenging. OBJECTIVE: To identify the interventions that have been investigated in the antenatal period in Nepal for maternal or neonatal benefit. We wanted to understand their scale, location, cost, and effectiveness. STUDY DESIGN: Online bibliographic databases (Cochrane Central, MEDLINE, Embase, CINAHL Plus, British Nursing Index, PsycInfo, Allied and Complementary Medicine) and trial registries (ClinicalTrials.gov and the World Health Organization Clinical Trials Registry Platform) were searched from their inception till May 24, 2020. We included all studies reporting any maternal or neonatal outcome after an intervention in the antenatal period. We screened the studies and extracted the data in duplicate. A meta-analysis was not possible because of the heterogeneity of the interventions and outcomes, so we performed a narrative synthesis of the included studies. RESULTS: A total of 25 studies met our inclusion criteria. These studies showed a variety of approaches toward improving antenatal care (eg, educational programs, incentive schemes, micronutrient supplementation) in different settings (home, community, or hospital-based) and with a wide variety of outcomes. Less than a quarter of the studies were randomized controlled trials, and many were single-site or reported only short-term outcomes. All studies reported having made a positive impact on antenatal care in some way, but only 3 provided a cost-benefit analysis to support implementation. None of these studies focused on the most remote communities in Nepal. CONCLUSION: Our systematic review found good quality evidence that micronutrient supplementation and educational interventions can bring important clinical benefits. Iron and folic acid supplementation significantly reduces neonatal mortality and maternal anemia, whereas birth preparedness classes increase the uptake of antenatal and postnatal care, compliance with micronutrient supplementation, and awareness of the danger signs in pregnancy. |
format | Online Article Text |
id | pubmed-8883503 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-88835032022-03-02 A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal Toolan, Miriam Barnard, Katie Lynch, Mary Maharjan, Nashna Thapa, Meena Rai, Nisha Lavender, Tina Larkin, Michael Caldwell, Deborah M. Burden, Christy Manandhar, Dharma S. Merriel, Abi AJOG Glob Rep Original Research BACKGROUND: Maternal and neonatal mortality rates remain high in many economically underdeveloped countries, including Nepal, and good quality antenatal care can reduce adverse pregnancy outcomes. However, identifying how to best improve antenatal care can be challenging. OBJECTIVE: To identify the interventions that have been investigated in the antenatal period in Nepal for maternal or neonatal benefit. We wanted to understand their scale, location, cost, and effectiveness. STUDY DESIGN: Online bibliographic databases (Cochrane Central, MEDLINE, Embase, CINAHL Plus, British Nursing Index, PsycInfo, Allied and Complementary Medicine) and trial registries (ClinicalTrials.gov and the World Health Organization Clinical Trials Registry Platform) were searched from their inception till May 24, 2020. We included all studies reporting any maternal or neonatal outcome after an intervention in the antenatal period. We screened the studies and extracted the data in duplicate. A meta-analysis was not possible because of the heterogeneity of the interventions and outcomes, so we performed a narrative synthesis of the included studies. RESULTS: A total of 25 studies met our inclusion criteria. These studies showed a variety of approaches toward improving antenatal care (eg, educational programs, incentive schemes, micronutrient supplementation) in different settings (home, community, or hospital-based) and with a wide variety of outcomes. Less than a quarter of the studies were randomized controlled trials, and many were single-site or reported only short-term outcomes. All studies reported having made a positive impact on antenatal care in some way, but only 3 provided a cost-benefit analysis to support implementation. None of these studies focused on the most remote communities in Nepal. CONCLUSION: Our systematic review found good quality evidence that micronutrient supplementation and educational interventions can bring important clinical benefits. Iron and folic acid supplementation significantly reduces neonatal mortality and maternal anemia, whereas birth preparedness classes increase the uptake of antenatal and postnatal care, compliance with micronutrient supplementation, and awareness of the danger signs in pregnancy. Elsevier 2021-08-29 /pmc/articles/PMC8883503/ /pubmed/35252905 http://dx.doi.org/10.1016/j.xagr.2021.100019 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Research Toolan, Miriam Barnard, Katie Lynch, Mary Maharjan, Nashna Thapa, Meena Rai, Nisha Lavender, Tina Larkin, Michael Caldwell, Deborah M. Burden, Christy Manandhar, Dharma S. Merriel, Abi A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal |
title | A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal |
title_full | A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal |
title_fullStr | A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal |
title_full_unstemmed | A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal |
title_short | A systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in Nepal |
title_sort | systematic review and narrative synthesis of antenatal interventions to improve maternal and neonatal health in nepal |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883503/ https://www.ncbi.nlm.nih.gov/pubmed/35252905 http://dx.doi.org/10.1016/j.xagr.2021.100019 |
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