Table 3 Studies of the impact of community skilled birth attendants on perinatal-neonatal mortality
Author | Study Years | Country | Setting | Study Design | Primary Intervention | Concurrent Interventions | Intervention Coverage | Total N A) Intervention B) Comparison | Outcomes Measured | Effect on outcome (95% CI) |
|---|---|---|---|---|---|---|---|---|---|---|
Ronsmans 2008[50] | 1975-1999 | Matlab, Bangladesh | Rural, 1987-1996 SBA at home | Quasi-experimental (†use of before-after data in pooled anlaysis) | Posting of midwives in villages to increase skilled home birth (antenatal, basic obstetric, care including labor monitoring, essential newborn care) until 1996. After 1996, facility based strategy with upgrading of health centers in basic obstetric care (partograph use, active management 3rd stage, antibiotics, magnesium) | Strengthening referral systems, Transport to BEMOC or CEmOC | 25% of births attended by SBA during home birth period | A) 19085 (ICDDR,B 1989-1995) B) 22821 (ICDDR,B 1982-1988) | 1) IPR-NMR 2) NMR † 3) ENMR† 4) PMR† | 1) 0.78 (NS) 2) 0.83 (0.76-0.91) 3) 0.89 (0.80-0.97) 4) 0.92 (0.84-0.98) |
Yan 1989[48] | 1983-1986 | Shunyi, China | Rural Shunyi County, 7 of 29 townships | Before-after | Village doctors-midwives identify risk and either manage (external cephalic version, blood pressure monitoring) or refer mothers to county hospital | Improvement of neonatal ward in county hospital | 96% of pregnant women seen by village doctor-midwife | A) 2335 B) 2212 | 1) PMR 2) EMR 3) IP-PMR | 1) 0.66 (0.44-0.98) 2) 0.77 (0.43-1.36) 3) 0.73 (*) |
Ibrahim 1992[49] | 1985-1988 | Khartoum, Sudan | Rural, 91% home delivery | Before-after | Training and upgrading of skills of village midwives (antenatal care, monitoring in labor) | Data collection maternal-perinatal outcomes, referral system to hospital | 91% of births delivered by village midwives | A) 2298 B) 3977 | 1) NMR 2) ENMR 3) SBR | 1) 0.68 (0.48-0.97) 2) 0.78 (0.61-1.01) 3) 0.85 (0.60-1.19) |
Alisjahbana 1995[51] | 1992-1993 | West Java, Indonesia | Rural villages, West Java; Tanjungsari district | Quasi-experimental (use of before-after data in pooled analysis) | Training physicians and village midwives on danger signs, case management in pregnancy, labor, delivery, postpartum; development of birthing homes | Training TBAs in pregnancy detection, complications and referral; communications and transportation | 92% of births with professional provider | A) 1176 B) 1099 | 1) PMR | 0.75 (0.51-1.10) |