Please provide a literature summary review of the evidence for interventions to reduce maternal and newborn mortality, including evidence of the impact of selective interventions such as training and equipment provision and the extent to which context is influential. Include cost benefit findings where relevant. Compare the strength of the evidence for selective versus comprehensive approaches.
Many of the papers in this report identify key interventions which are then recommended to be delivered using an integrated or continuum of care approach. The evidence also emphasises the need for attention to the local situation when implementing interventions and note the limitations of vertical programmes in addressing co-morbidities.
The report consists of the following sections:
- Evidence of the impact of selective interventions
- Key and packaged interventions
- Integrated primary health care
- Community-based interventions
- Cost findings
- Specialist input from IPACT
Some key findings from the papers reviewed include:
- Inclusion of evidence-based interventions in primary healthcare could prevent deaths.
- Outcomes can be improved through integrated packages of cost-effective health-care interventions that are implemented incrementally in accordance with the capacity of health systems.
- A health centre intrapartum-care strategy that incorporates EmOC is recommended.
The most cost effective mix of interventions for countries in Africa and SE Asia with high mortality rates are the community-based newborn care package, followed by antenatal care (tetanus toxoid, screening for pre-eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis), skilled attendance at birth, offering first level maternal and neonatal care around childbirth and emergency obstetric and neonatal care around and after birth