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

From: Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings

Reviews (n=16) Description of included interventions Type of studies included (no) Targeted health care providers Outcome reported Pooled data (Y/N) Results
     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