Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh

• Type of Material: Article
• Authors: Anisur Rahman, Centre for Reproductive Health; Allisyn Moran, Centre for Reproductive Health; Jesmin Pervin, Centre for Reproductive Health; Aminur Rahman, Centre for Reproductive Health; Monjur Rahman, Centre for Reproductive Health; Sharifa Yeasmin, Centre for Reproductive Health; Hosneara Begum, Centre for Reproductive Health; Harunor Rashid, Centre for Reproductive Health; Mohammad Yunus, Centre for Reproductive Health; Daniel Hruschka, Arizona State University; Shams E. Arifeen, Centre for Reproductive Health; Peter K. Streatfield, Centre for Reproductive Health; Lynn Sibley, Emory University; Abbas Bhuiya, Centre for Reproductive Health; Marge Koblinsky, John Snow, Inc
• Language: English
• Date: 2011-12-10
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2011 Rahman et al.; licensee BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://dx.doi.org/10.1186/1471-2458-11-914
• Title of Journal or Parent Work: BMC Public Health
• ISSN: 1471-2458
• Volume: 11
• Start Page: 914
• End Page: 914
• Grant/Funding Information: This research study was funded by icddr, b and its donors which provide unrestricted support to icddr, b for its operations and research.; We gratefully acknowledge these donors for their support and commitment to icddr, b's research efforts.; Current donors providing unrestricted support include: Australian Agency for International Development (AusAID), Government of the People's Republic of Bangladesh; Canadian International Development Agency (CIDA), Swedish International Development Cooperation Agency (Sida), and the Department for International Development, UK (DFID).
• Keywords: INTERVENTIONS; NEONATAL-MORTALITY; Science & Technology; RANDOMIZED CONTROLLED-TRIAL; DEVELOPING-COUNTRIES; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; BIRTH-WEIGHT INFANTS; SERVICE-DELIVERY; PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH, SCI; MATERNAL MORTALITY; NEWBORN; OUTCOMES; KANGAROO MOTHER CARE
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background: Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. Methods. This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods - before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Results: Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018). Conclusion: The continuum of care approach provided through the integration of service delivery modes decreased the perinatal mortality rate within a short period of time. Further testing of this model is warranted within the government health system in Bangladesh and other low-income countries.