Effectiveness of a continuum of care in maternal health services on the reduction of maternal and neonatal mortality: Systematic review and meta-analysis

Muluwas Amentie Zelka; Alemayehu Work Yalew; Gurmesa Tura Debelew

doi:10.1016/j.heliyon.2023.e17559

Effectiveness of a continuum of care in maternal health services on the reduction of maternal and neonatal mortality: Systematic review and meta-analysis

Heliyon. 2023 Jun 22;9(6):e17559. doi: 10.1016/j.heliyon.2023.e17559. eCollection 2023 Jun.

Authors

Muluwas Amentie Zelka^{1

2}, Alemayehu Work Yalew³, Gurmesa Tura Debelew⁴

Affiliations

¹ Department of Public Health, College of Health Sciences, Assosa University, Assosa, Ethiopia.
² Department of Reproductive Health, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
³ Department of Biostatistics and Epidemiology, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
⁴ Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.

Abstract

Background: Sustainable Development Goals -3 (SDG - 3) were to ensure healthy live and promote well-being by reducing global maternal and neonatal deaths. These were to be implemented through the concept of continuum of care in maternal health program framework to improve health outcomes. There is a paucity of published evidences; as such, this review is designed to assess the effectiveness of the concept of continuum of care in maternal and neonatal health services on the reduction of maternal and neonatal mortality.

Methods: A search was conducted using the key words; maternal and neonatal, health services, continuum of care, maternal and neonatal mortality. Search focused on PubMed, Cochrane, MEDLINE and Google Scholar. Extractions of articles were done based on predetermine criteria. Data were compiled, and screened, entered and analysis was done using STATA 13 and Rev. Man. software. Effects of the intervention package were determined and the result was interpreted in random effect RR with 95%CI. The publication bias was determined by using funnel plot, Egger and Bagger test, heterogeneity, and sensitivity test.

Results: A total of 4685 articles were retrieved of these 20 articles reviewed. Articles on 631,975 live births (LBs) were analyzed. Results showed the distribution as follows; 23,126 newborns died within 28 days resulting [NMR = 35/1000LBs among the intervention group whereas NMR = 39/1000LBs among the control group]. The pooled effect of the intervention was significantly reduced neonatal mortality (RR = 0.84; 95%CI: 0.77-0.91). Similarly, 1268 women died during the pregnancy period up to 42 days after childbirth that resulted [MMR = 330/100,000LBs among the intervention group whereas MMR = 460/100,000LBs among the control group]. The pooled effect of the intervention was not a statistically significant association with maternal mortality (RR = 0.64; 95%CI: 0.41-1.00).

Conclusion: Adoption of continuum of care concepts in maternal health services reduced maternal and neonatal mortality. We recommend strengthening and effective implementation of a continuum of care in maternal health services to improve maternal and neonatal health care outcomes.

Keywords: Continuum; Health; Maternal; Mortality; Neonatal.