Table 1 Characteristics of the included reviews for outreach services, home visitation and referrals

Other outcomes

MNCH specific outcomes

Blondel 1995[29]

Two different types of home visits during pregnancy: (1) those offering social support to high-risk women; and (2) those providing medical care to women with complications.

RCT’s: 08

Nurses, family workers, midwives in HIC

Preterm delivery

Yes

1.0 (0.8-1.1)

Hospital admission with complications

0.9 (0.7-1.2)

Bull 2004 (Overview)[45]

Home visiting is not a single or uniform intervention – it is a mechanism for the delivery of a variety of interventions directed at different outcomes. They may provide parent training/education, pyscho-social support to parents, infant stimulation, and infant and maternal health surveillance

Reviews: 09

Nurses, midwives or lay people within different professional bases in HIC

Pregnancy outcome

No

No impact

Immunization rate

No impact

Hospital admission

No impact

Child injury

Positive impact

Post natal depression

Positive impact

Ciliska 2001[30]

Public health nursing interventions when carried out by the strategy of home visiting of clients in the pre- and postnatal period

20 studies

RCT's: 8

CCT: 3 analytic cohort: 1

Nurses or midwives in HIC

Children’s mental development, mental health and physical growth, mother’s depression, maternal employment, education, nutrition and other health habits, and government cost saving.

No

No negative impacts reported in 12 strong articles

Children mental and physical health improved

No impacts on LBW, gestational age and neonatal morbidity and mortality

Elkan 2000[31]

Home visiting program with at least one postnatal visit

102 papers with 86 home visiting programs

Nurses or midwives in HIC

Mental development score

Yes

0.17 (0.06-0.28)

Motor development score

0.17(–0.03-0.38)

IQ

0.32 (0.146-0.48)

Weight

0.04 (–0.17-2.46)

Height

0.04 ( –0.17-2.5)

Immunization rate

1.40 (1.16-1.68)

Use of acute care

0.73 (0.55-0.98)

Hospital stay

1.63 (1.18-2.24)

ER

0.77 (0.58-1.03)

Gogia 2010[32]

Implementation by community health workers of safe delivery practices at home and proper care of the neonate immediately after birth, such as keeping the baby warm, providing neonatal resuscitation (if required) and initiating breastfeeding early.

RCT: 05

CHW in LIC

ANC visit >1

Yes

1.33 (1.20-1.47)

Tetanus Toxoid (2 doses)

1.11 (1.04-1.18)

Skilled care at birth

1.54 (0.81 - 2.93)

Breastfeeding within 1 hour

3.35 (1.31-8.59)

Clean cord care

1.70 (1.39-2.07)

Delayed bathing

4.63 (2.29-9.37)

Neonatal mortality

0.62 (0.44-0.87)

Infant mortality

0.41 (0.30–0.57)

Neonatal cause-specific mortality due to:

Sepsis

89.8% (78.6–101.0)

Asphyxia

53.3% (23.8–82.8)

Prematurity

38% (4.3–71.6)

Hypothermia

100% (one-sided 95% CI not stated)

Gruen 2003[33]

Specialist outreach clinics: defined as planned and regular visits by specialist-trained medical practitioners from a usual practice location (hospital or specialist center) to primary care or rural hospital settings.

RCT: 05

CBA: 02

ITS: 02

Primary healthcare practitioners and specialists

Adherence to treatment

Yes

0.63 (0.52-0.77)

Patient and provider satisfaction

0.43 (0.29-0.62)

Use of service

0.14 (0.05-0.32)

Hodnett 2000[34]

Standardized or individualized programs of additional social support provided in either home visits, during regular antenatal clinic visits, and/or by telephone on several occasions during pregnancy.

RCT: 17

Multidisciplinary teams of health professionals specially trained lay workers, or combination of lay and professional workers.

Caesarean birth

0.87 (0.78-0.97)

Gestational age less than 37 weeks at birth

0.92 (0.83-1.01)

Birth weight less than 2500 gm

0.92 (0.83-1.03)

Stillbirth/neonatal death

0.96 (0.74-1.26)

Antenatal hospital admission

0.79 (0.68-0.92)

Postnatal re-hospitalization

1.60 (0.80-3.21)

Antenatal depression

0.77 (0.50, 1.19)

Postnatal depression

0.85 (0.69-1.05)

Less than highly satisfied with antenatal care

1.13 (0.76, 1.67)

Hussein 2012[35]

Interventions included aimed to overcome delays in reaching the appropriate facility, which improved emergency referrals antenatally, during labour, or up to 42 d after delivery.

Total: 19

RCT: 04,controlled before after: 05,Cohort: 05

Community groups and TBA

Neonatal mortality

No

0.48 (0.34-0.68)

Stillbirths

0.56 (0.32-0.96)

Hussein 2012[36]

Refer pregnant and post-partum women suffering from an emergency obstetric complication or from home to basic-level health facilities (health centres) and from health centre to hospital (but not referral between hospitals) in LMIC

Total: 19

RCT: 04,controlled before after: 05,Cohort: 05

Community groups and TBA

Neonatal mortality

No

0.48 (0.34-0.68)

Stillbirths

0.56 (0.32-0.96)

Issel 2011[37]

Prenatal home visiting was defined as a nonmedical program or service focused on facilitating utilization of health or social services, provided in the home to pregnant women who were at high medical or social risk for adverse birth outcomes.

Total : 28

RCT: 14, descriptive: 2, retro cohort: 07, prospect cohort: 02, matched CC: 01, ecological : 01, static group: 01

Home visiting personnel not defined

PNC utilization

No

5/5 studies found significant improvement

Gestational age

5/24 found a significant positive effect

Birth weight

7/17 found a significant positive effect

Kandrick 2000[38]

The home visitation program had to include at least one post natal home visits

11 RCT’s (9 meta-analyzed)

Nurses and midwives in HIC

Immunization uptake

Yes

1.17 (0.33-4.17) (Random)

1.67 (1.29-2.15) (fixed)

Lassi 2010[39]

Intervention packages that included additional training of outreach workers in maternal care during pregnancy, delivery and in the postpartum period; and routine newborn care.

18 cluster-randomized/quasi-randomized trials

outreach workers in LMIC

Maternal mortality

Yes

0.77 (0.59-1.02)

Maternal morbidity

0.75 (0.61-0.92)

Neonatal mortality

0.76 (0.68-0.84)

Perinatal mortality

0.80 (0.71-0.91)

Referral

1.4 (1.19-1.65)

Early breast feeding

1.94 (1.56-2.42)

Lonkhuijzen 12 [44]

All types of facilities within easy reach of a medical facility that are designated for the lodging of pregnant women who await labour, with the purpose of the women being assisted by skilled attendants during delivery

None

Not applicable

Not applicable

McNaughton 2004[40]

Home-visiting interventions using professional nurses as home visitors.

13 reports

Nurses in HIC

Maternal newborn health status

No

Narrative (more than half of the studies were able to achieve their desired results)

Peacock 2013[43]

Effect of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families.

21 studies

Paraprofessional home-visiting staff

Child abuse and neglect

No

3 out of 6 studies showed better outcomes

Physical growth

5 out of 7 studies showed no significant improvement

Hospitalization, illness and injuries

2 out of 6 studies showed better health outcomes

Up-to date immunizations

1 study showed intervention group more likely to receive primary immunizations

Pyone 2012[41]

Distance and transport cost related interventions

5 studies

Community

MMR (associated with distance)

No

7.4 (1.6 – 132.4)

Vieira 2012[42]

Interventions to increase birth with skilled health personnel, in settings where TBAs were providers of childbirth care

6 observational studies

Skilled birth attendant

Obstetric mortality ratio

No

Deploying skilled health personnel and addressing financial barriers for users increased the use of skilled health personnel at birth

Decrease in maternal deaths

Birth by a physician

Birth by C-Section

Increase in skilled birth attendance