From: Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings
Description of included interventions
Type of studies included (no)
Targeted health care providers
Pooled data (Y/N)
MNCH specific outcomes
In-service training to health personnel only, defined as SBAs (nurses, midwives, doctors or health personnel with midwifery skills) for better maternal outcomes.
Before after:08, Quais:02, Cross-sectional: 2
Skilled birth attendants (doctors, nurses and midwives) as well as to other service providers (lab tech) in LMIC
Mean antenatal visits
The distribution of published or printed recommendations for clinical care and evidence to inform practice, including clinical practice guidelines, journals and monographs.
All health care professionals
PEM vs. no intervention
Practice outcomes: (categorical)
Median absolute risk difference 0.02 (range 0, 0.11) i.e. 2% absolute improvement
Profession practice outcomes: (continuous)
median improvement in standardised mean difference 0.13 (range -0.16, 0.36)
We included the following types of educational meetings: conferences, lectures, workshops, seminars, symposia, and courses.
Qualified health professionals or health professionals in postgraduate training mostly in HIC
Any intervention with educational meeting vs. no intervention:
Only educational meeting vs. no intervention:
Achievement of treatment goal
Within the professional oriented interventions we distinguished between conceptually different interventions: information transfer, learning through social influence, feedback and reminders.
Family physicians, general internists, gynaecologists, obstetricians, pediatricians and sometimesother professionals like nurse practitioners and radiologists in HIC
Group education vs. no intervention
Range: -4% - 31%
Multifaceted interventions versus group education
Range: -31% - 28%
Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results and relevance to an individual’s work.
Doctors, midwives, managers and researchers
14/16 comparisons showed positive effect
4/4 comparisons showed positive impact
Intervention packages that included additional training of outreach workers namely, female health workers/visitors, community midwives, community/village health workers, facilitators or TBAs in maternal care during pregnancy, delivery and in the postpartum period; and routine newborn care.
18 cluster-randomized/quasi-randomized trials
Outreach workers namely, female health workers/visitors, community midwives, community/village health workers, facilitators or TBAs in LMIC
Early breast feeding
Interventions may include but are not limited to the distribution of printed educational material, educational meetings, audit and feedback, reminders, and patient-mediated interventions
Healthcare professionals, residents, fellows, and other pre licensurehealthcare professional
Adoption of shared decision making:
Both patient mediated interventions
Multifaceted intervention vs usual care
CPGs were defined as ‘‘systematically developed statements to assist practitioner decisions about appropriate healthcare for specific clinical circumstances.’’
cRCT: 10, before after: 10, ITS: 1
17/19 studies showed significant improvements
6/9 studies showed significant but small improvements
The conscientious explicit and judicious use of current evidence in making decisions about the care of individual patients
Medical students, residents
Mean gain 17.0%; [SD] 4.0%).
Mean gain 1.3%; SD 1.7%).
Educational outreach visits, defined as use of a trained person from outside the practice setting who meets with healthcare professionals in their practice settings to provide information with the intent of changing their performance.
Following in-service training courses aimed at changing provider behavior in the care of the seriously ill newborn or child: Neonatal and pediatric life support courses e.g. NLS, NRP, PALS, PLS, and others. Life support elements. Other in-service newborn and child health training courses aimed at the recognition and management of the seriously ill child
Doctors (general practitioners and specialists), nurses, pharmacists and dieticians/nutritionists, in outpatient or hospital-based settings in LMIC
Performance of adequate initial resuscitation steps
Frequency of inappropriate and potentially harmful practices
Participation of health care providers in conferences, lectures, workshops or traineeships outside their practice settings.
General healthcare providers
Change in health outcome and performance
An IPE intervention occurs when members of more than one health and/or social care profession learn interactively together, for the explicit purpose of improving inter-professional collaboration and/or the health/well being of patients/clients.
Health and social care professionals
4/6 reported positive outcomes
Collaborative team behavior
Reduction in clinical error
Trained birth attendants training
Trained birth attendants
Trained birth attendants versus untrained birth attendants:
Adjusted OR (95% CI)
0.69 (0.57 to 0.83)
0.70 (0.59 to 0.83)
0.74 (0.45 to 1.22)
1.50 (1.18 to 1.90)
0.71 (0.61 to 0.82)
1.26 (1.03 to 1.54)
0.61 (0.47 to 0.79)
0.17 (0.13 to 0.23)
Educational intervention was problem based learning
Post graduate continuing education in HIC
Participant’s knowledge, performance, satisfaction
Effect of clinical guideline on behavior of nurses, midwives or PAM's, on patient outcomes
Nursing, midwifery, health visiting, podiatry, speech and language therapy, physiotherapy and occupational therapy, pharmacy and radiography
Information transfer through group education, reading material and patient education
Physicians in HIC
Effectiveness against the reported outcome measures
Interventions to improve medical practice like dissemination strategies such as conferences or mailing
Physicians in HIC
5/13 studies showed statistically significant results