Abdul Baten, Raaj Kishore Biswas, Evie Kendal, Jahar Bhowmik
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引用次数: 0
Abstract
Background: Maternal mortality is a critical public health issue, especially in low- and middle-income countries (LMICs). Maternal healthcare services (MHS), including antenatal care (ANC) visits, skilled birth attendants (SBA), institutional delivery (ID), and postnatal care (PNC), are crucial policy priorities to address maternal mortality and improve pregnancy outcomes. This systematic review and meta-analysis aimed to provide a comprehensive, quantitative analysis of MHS utilization among women in LMICs.
Methods: We conducted a comprehensive search on PubMed, Scopus, Web of Science, CINAHL, and SocINDEX to gather relevant studies on the utilization of MHS in LMICs conducted between January 2015 and December 2024. These were then synthesized both quantitatively and qualitatively and random-effect models were employed to obtain pooled estimates.
Results: A total of 145 studies included in this review. Coverage of at least one ANC visit (ANC1), at least four ANC visits (ANC4), SBA, ID and PNC were reported in 66, 108, 42, 63, and 37 studies respectively and for these studies pooled prevalences of ANC1, ANC4, SBA, ID, and PNC were found 85.0% (95% CI 81.2-88.1%), 50.8% (95% CI 46.4-55.2%), 65.6% (95% CI 58.7-71.9%), 66.9% (95% CI 60.3-72.9%), and 48.9% (95% CI 41.7-56.2%), respectively, with high heterogeneity among the studies (I2 > 99.0%). Results obtained from the sub-group analysis revealed that the prevalence of MHS indicators was higher in the South and Southeast Asia (SSEA) region compared to Sub-Saharan Africa (SSA), except for ID, e.g., SBA prevalence in SSEA was 70.1% (95% CI 60.4-78.3%) whereas for SSA it was 64.0% (95% CI 53.3-73.6%). The prevalence of all MHS indicators was higher for studies with primary data than those with secondary data, except for ANC4 and PNC. Overall, associations were reported between MHS utilization and women's age, education level, household socioeconomic status, place of residence, decision-making power, and exposure to mass media.
Conclusion: High heterogeneity among studies infer possible disparities in MHS utilization at both global and national levels. Hence, it is crucial for policies to prioritize enhancing effective coverage, narrowing disparities, and improving care quality in alignment with the Sustainable Development Goals.
背景：产妇死亡率是一个重要的公共卫生问题，特别是在低收入和中等收入国家。孕产妇保健服务（MHS），包括产前护理（ANC）访问、熟练助产士（SBA）、机构分娩（ID）和产后护理（PNC），是解决孕产妇死亡率和改善妊娠结局的关键政策重点。本系统综述和荟萃分析旨在提供中低收入国家妇女MHS使用情况的全面定量分析。方法：综合检索PubMed、Scopus、Web of Science、CINAHL、SocINDEX等数据库，收集2015年1月至2024年12月期间关于MHS在中低收入国家应用的相关研究。然后对这些数据进行定量和定性综合，并采用随机效应模型获得汇总估计。结果：本综述共纳入145项研究。分别在66、108、42、63和37项研究中报道了至少一次ANC就诊（ANC1）、至少4次ANC就诊（ANC4）、SBA、ID和PNC的覆盖率，这些研究中，ANC1、ANC4、SBA、ID和PNC的总患病率分别为85.0% （95% CI 81.2-88.1%）、50.8% （95% CI 46.4-55.2%）、65.6% （95% CI 58.7-71.9%）、66.9% （95% CI 60.3-72.9%）和48.9% (95% CI 41.7-56.2%)，研究之间存在高度异质性（I2 bb0 99.0%）。亚组分析结果显示，除了ID外，南亚和东南亚（SSEA）地区MHS指标的患病率高于撒哈拉以南非洲（SSA），例如，SSEA地区SBA患病率为70.1% (95% CI 60.4-78.3%)，而SSA地区为64.0% （95% CI 53.3-73.6%）。除ANC4和PNC外，所有MHS指标的流行率在有第一手资料的研究中均高于有第二手资料的研究。总体而言，MHS的使用与妇女的年龄、教育水平、家庭社会经济地位、居住地、决策权和接触大众媒体之间存在关联。结论：研究之间的高度异质性表明全球和国家层面的MHS利用可能存在差异。因此，至关重要的是，政策应根据可持续发展目标优先考虑扩大有效覆盖面、缩小差距和提高护理质量。系统评价注册：PROSPERO CRD42023401745。
期刊介绍：
Systematic Reviews encompasses all aspects of the design, conduct and reporting of systematic reviews. The journal publishes high quality systematic review products including systematic review protocols, systematic reviews related to a very broad definition of health, rapid reviews, updates of already completed systematic reviews, and methods research related to the science of systematic reviews, such as decision modelling. At this time Systematic Reviews does not accept reviews of in vitro studies. The journal also aims to ensure that the results of all well-conducted systematic reviews are published, regardless of their outcome.
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