'First 1000 days' health interventions in low- and middle-income countries: alignment of South African policies with high-quality evidence

René English; Nazia Peer; Simone Honikman; Aviva Tugendhaft; Karen J Hofman

doi:10.1080/16549716.2017.1340396

'First 1000 days' health interventions in low- and middle-income countries: alignment of South African policies with high-quality evidence

Glob Health Action. 2017;10(1):1340396. doi: 10.1080/16549716.2017.1340396.

Authors

René English^{1

2}, Nazia Peer¹, Simone Honikman³, Aviva Tugendhaft⁴, Karen J Hofman⁴

Affiliations

¹ a Health Systems Trust, Health Systems Research Unit , Cape Town , South Africa.
² b School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa.
³ c Perinatal Maternal Mental Health, The Alan J Flisher Centre for Public Mental Health , University of Cape Town , Cape Town , South Africa.
⁴ d Priority Cost Effective Lessons for System Strengthening South Africa, School of Public Health , University of the Witwatersrand , Johannesburg , South Africa.

Abstract

Background: In South Africa (SA), despite adoption of international strategies and approaches, maternal, neonatal and child (MNC) morbidity and mortality rates have not sufficiently declined.

Objectives: To conduct an umbrella review (UR) that identifies interventions in low- and middle-income countries, with a high-quality evidence base, that improve MNC morbidity and mortality outcomes within the first 1000 days of life; and to assess the incorporation of the evidence into local strategies, guidelines and documents.

Methods: We included publications about women and children in the first 1000 days of life; healthcare professionals and community members. Comparators were those who did not receive the intervention. Interventions were pharmacological and non-pharmacological. Outcomes were MNC morbidity and mortality. Authors conducted English language electronic and manual searches (2000-2013). The quality of systematic reviews and meta-analyses (SRs/MAs) were reviewed. Interventions were ranked according to level of evidence; and then aligned with SA strategies, policies and guidelines. A tool to extract data was developed and used by two authors who independently extracted data. Summary measures from MAs or summaries of SRs were reviewed and the specificities of the various interventions listed. A search of all local high-level documents was done and these were assessed to determine the specificities of the recommendations and their alignment to the evidence.

Results: In total, 19 interventions presented in 32 SRs were identified. Overall, SA's policymakers have sufficiently included high-quality evidence-based interventions into local policies. However, optimal period of birth spacing (two to five years) is not explicitly promoted nor was ante- and postnatal depression adequately incorporated. Antenatal care visits should be increased from four to about eight according to the evidence.

Conclusion: Incorporation of existing evidence into policies can be strengthened in SA. The UR methods are useful to inform policymaking and identify research gaps. RESPONSIBLE EDITOR Nawi Ng, Umeå University, Sweden.

Keywords: First 1000 days; South Africa; child health; interventions; maternal; neonatal.

MeSH terms

Child Mortality / trends
Child, Preschool
Developing Countries / statistics & numerical data*
Female
Humans
Infant
Infant Mortality / trends
Infant, Newborn
Maternal Health Services / organization & administration*
Maternal Health Services / standards
Maternal Mortality / trends
Morbidity
Mortality / trends*
Policy
Pregnancy
Prenatal Care / standards
Prenatal Care / statistics & numerical data
Program Evaluation
South Africa / epidemiology

Grants and funding

This work was funded by a grant from the SA Medical Research Council through the SA National Department of Health [grant number D1305910-01]: PEECHI (Programme for the Economic Evaluation of Child and Maternal Health Interventions).