Protocol for a systematic review on inequalities in postnatal care services utilization in low- and middle-income countries

Mobile health (mHealth) technologies have been implemented in many low- and middle-income countries to address challenges in maternal and child health. Many of these technologies attempt to influence patients’, caretakers’, or health workers’ behavior. The purpose of this study was to conduct a systematic review of the literature to determine what evidence exists for the effectiveness of mHealth tools to increase the coverage and use of antenatal care (ANC), postnatal care (PNC), and childhood immunizations through behavior change in low- and middle-income countries. The full text of 53 articles was reviewed and 10 articles were identified that met all inclusion criteria. The majority of studies used text or voice message reminders to influence patient behavior change (80%,n=8) and most were conducted in African countries (80%,n=8). All studies showed at least some evidence of effectiveness at changing behavior to improve antenatal care attendance, postnatal care attendance, or childhood immunization rates. However, many of the studies were observational and further rigorous evaluation of mHealth programs is needed in a broader variety of settings.

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Inequities in postnatal care in low- and middle-income countries: a systematic review and meta-analysis

Bulletin of the World Health Organization ◽

10.2471/blt.14.140996 ◽

2015 ◽

Vol 93 (4) ◽

pp. 259-270G ◽

Cited By ~ 46

Author(s):

Étienne V Langlois ◽

Malgorzata Miszkurka ◽

Maria Victoria Zunzunegui ◽

Abdul Ghaffar ◽

Daniela Ziegler ◽

...

Keyword(s):

Systematic Review ◽

Postnatal Care ◽

Meta Analysis ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review

Neuroepidemiology ◽

10.1159/000479518 ◽

2017 ◽

Vol 49 (1-2) ◽

pp. 45-61 ◽

Cited By ~ 29

Author(s):

Jeyaraj Durai Pandian ◽

Akanksha G. William ◽

Mahesh P. Kate ◽

Bo Norrving ◽

George A. Mensah ◽

...

Keyword(s):

Systematic Review ◽

Health Care Services ◽

Cost Effective ◽

Stroke Care ◽

Evidence Based ◽

Middle Income ◽

Middle Income Countries ◽

Care Services ◽

Stroke Services ◽

Low And Middle Income

Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services. Aims and Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care. Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included. Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible. Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.

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Interventions to improve school-based eye-care services in low- and middle-income countries: a systematic review

Bulletin of the World Health Organization ◽

10.2471/blt.18.212332 ◽

2018 ◽

Vol 96 (10) ◽

pp. 682-694D ◽

Cited By ~ 2

Author(s):

Anthea M Burnett ◽

Aryati Yashadhana ◽

Ling Lee ◽

Nina Serova ◽

Daveena Brain ◽

...

Keyword(s):

Systematic Review ◽

Eye Care ◽

Middle Income ◽

Middle Income Countries ◽

Care Services ◽

School Based ◽

Low And Middle Income

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Impact of mHealth interventions on antenatal and postnatal care utilization in low and middle-income countries: A Systematic Review and Meta-Analysis

10.1101/2020.12.22.20248713 ◽

2020 ◽

Author(s):

Ravi Kant ◽

Poonam Yadav ◽

Surekha Kishore ◽

Shruti Barnwal ◽

Rajesh Kumar ◽

...

Keyword(s):

Systematic Review ◽

Antenatal Care ◽

Postnatal Care ◽

Meta Analysis ◽

Care Utilization ◽

Middle Income ◽

Mhealth Intervention ◽

Middle Income Countries ◽

Antenatal And Postnatal Care ◽

Low And Middle Income

ABSTRACTObjectiveTo evaluate the effectiveness of mHealth interventions on antenatal and postnatal care utilization in low and middle-income countries.DesignSystematic review and meta-analysisSettingStudies from low and middle-income countries were included for analysis.ParticipantsWe searched the literature through major electronic databases such as PubMed, MEDLINE, Embase, Cochrane, Scopus, CINAHL, Clinical key, Google Scholar, Ovid databases with selected keywords, and explored the reference list of articles. Meta-analysis was performed in RevMan 5.4 software; p-value < 0.05 was considered statistically significant. The effect of variables was measured in the Odds ratio with a fixed-effect model. Six published interventional studies were selected as per the eligibility and PICO framed for the systematic review and meta-analysis. Search restricted to articles in the English language, online published, and preprint articles till September 2020.Primary and secondary outcome measuresWe evaluated the effectiveness of mHealth intervention on antenatal care utilization, including four antenatal check-ups, iron-folic acid supplementation, two tetanus toxoid immunizations, and postnatal care utilization, which includes postnatal check-ups of delivered mothers.ResultsResults have been presented in the form of a forest plot. Findings of this meta-analysis depicted the significant increase in four or more antenatal care attendance (OR=1.89, 95% CI-1.49-2.19), TT immunization (OR=1.63 (95% CI-1.17-2.27), compliance to iron supplementation (OR=1.88, 95% CI-1.18-3.00) and postnatal care attendance (OR=2.54 (95% CI-2.15-2.99) among those pregnant mothers who received mHealth intervention compared to control group.ConclusionThis meta-analysis concluded that m-health has the potential to increase the utilization of full antenatal care and postnatal care compared to standard care, although the level of evidence is moderate.Trial registrationCRD42020204618, PROSPERO, International prospective register of systematic reviewsArticle SummaryStrengths and limitations of this studyThis meta-analysis creates an evidence for the effectiveness of mHealth with pooled data of interventional studies with limited sample sizes.Technology is changing, but even with limited support like SMS, there was an improvement in antenatal and postnatal service utilization.Sensitivity analysis identified possible reasons for heterogeneity among studies.Studies included from LMICs so results can be generalized for the respective population.mHealth as an intervention is a broad term that created heterogeneity also.

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