Table 4 Studies of the impact of community skilled birth attendants on perinatal-neonatal mortality, excluded from meta-analysis
Author | Study Years | Country | Setting | Study Design | Primary Intervention | Concurrent Interventions | Intervention Coverage | Total N A) Intervention B) Comparison | Outcome Measured | Effect on outcome RR/OR (95% CI) |
|---|---|---|---|---|---|---|---|---|---|---|
Matthews 2004[59] | 1999-2002 | Ghana | Rural Brong Ahafo district | Before-after | Training midwives in health facilities on use of partograph and emergency obstetric skills | TBA Training in danger signs, Emergency obstetric transport service | NS | A) 768 B) 575 | 1) PMR | NS |
Andersson 2000[55] | 1831-1899 | Sweden | 18 Parishes Northern Sweden | Historical | 1829 Training of midwives in use of forceps, "sharp hooks and perforators" | 1881 antiseptic techniques | 73% of home deliveries attended by midwives at endline (43% baseline) | NS | 1) PMR | 1) 0.71(0.62-0.82) |
Hatt 2009[56] | 1986-2002 | Indonesia | National DHS Data | Historical | Village midwife training program started in 1989, by 1995 50,000 trained. In 1996 competency based training, neonatal resuscitation | 2 decades of national perinatal care and obstetric care upgrading | Proportion of deliveries attended by midwives increased from 12% (1986) to 30% (2002) | NS | 1) ENMR 2) First day mortality | 1) 0.97 (0.95-0.99) per year reduction 2) 0.98(0.95-1.02) per year reduction |
Koblinsky 1999[40] | 1957-1990s | Malaysia | National NMR | Historical-ecological | 1960 s Training of professional village midwives, linking to regional clinics, referral to district hospitals; 1980's shift to facility births | 3 decades of perinatal care and obstetric care upgrading | By 1986, 95% of home births by midwives; by 1995, 88% institutional delivery; 90% of women with high risk, 80% moderate risk delivering in hospitals | NS | 1) NMR | NMR from 75.5 (1957) to 14.8 (1991) |
PATH 2006[58] | 2003-2004 | Cirebon, Indonesia | Rural Cirebon district, west Java, pop 2 mill | Before-After | Training mid-wives in management of labor, birth asphyxia, tube-mask resuscitation, refresher training/supervision | 60% of asphyxia cases managed by midwives. Uncertain coverage | Est 44000 | 1) IPR-NMR 2) NMR 3) SBR | 1) 0.39 (0.31- 0.48) 2) 0.60 (0.53-0.68) 3) 0.39 (0.31-0.48) | |
Shankar 2008[57] | 1989-2003 | Indonesia | National NMR | Historical | Village midwife training program started in 1989, by 1995 50,000 trained. In 1996 competency based training program including neonatal resuscitation | 2 decades of national perinatal care and obstetric care upgrading | In rural areas skilled attendance increased from 22% to 55% | NS | 1) NMR | NMR decreased from 32 to 20/1000 over 14 years |