Effectiveness of an integrated approach to reduce perinatal mortality

Recent experiences from Matlab, Bangladesh

Anisur Rahman, Allisyn Moran, Jesmin Pervin, Aminur Rahman, Monjur Rahman, Sharifa Yeasmin, Hosneara Begum, Harunor Rashid, Mohammad Yunus, Daniel Hruschka, Shams E. Arifeen, Peter K. Streatfield, Lynn Sibley, Abbas Bhuiya, Marge Koblinsky

Research output: Contribution to journalArticle

18 Citations (Scopus)

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.

Original languageEnglish (US)
Article number914
JournalBMC Public Health
Volume11
DOIs
StatePublished - 2011

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Bangladesh
Perinatal Mortality
Health
Continuity of Patient Care
Mortality
Demography
Pregnancy
Stillbirth
Child Development
Cesarean Section
Odds Ratio
Confidence Intervals
Survival
Child Health
Infant Health
Maternal Health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Effectiveness of an integrated approach to reduce perinatal mortality : Recent experiences from Matlab, Bangladesh. / Rahman, Anisur; Moran, Allisyn; Pervin, Jesmin; Rahman, Aminur; Rahman, Monjur; Yeasmin, Sharifa; Begum, Hosneara; Rashid, Harunor; Yunus, Mohammad; Hruschka, Daniel; Arifeen, Shams E.; Streatfield, Peter K.; Sibley, Lynn; Bhuiya, Abbas; Koblinsky, Marge.

In: BMC Public Health, Vol. 11, 914, 2011.

Research output: Contribution to journalArticle

Rahman, A, Moran, A, Pervin, J, Rahman, A, Rahman, M, Yeasmin, S, Begum, H, Rashid, H, Yunus, M, Hruschka, D, Arifeen, SE, Streatfield, PK, Sibley, L, Bhuiya, A & Koblinsky, M 2011, 'Effectiveness of an integrated approach to reduce perinatal mortality: Recent experiences from Matlab, Bangladesh', BMC Public Health, vol. 11, 914. https://doi.org/10.1186/1471-2458-11-914
Rahman, Anisur ; Moran, Allisyn ; Pervin, Jesmin ; Rahman, Aminur ; Rahman, Monjur ; Yeasmin, Sharifa ; Begum, Hosneara ; Rashid, Harunor ; Yunus, Mohammad ; Hruschka, Daniel ; Arifeen, Shams E. ; Streatfield, Peter K. ; Sibley, Lynn ; Bhuiya, Abbas ; Koblinsky, Marge. / Effectiveness of an integrated approach to reduce perinatal mortality : Recent experiences from Matlab, Bangladesh. In: BMC Public Health. 2011 ; Vol. 11.
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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.",
author = "Anisur Rahman and Allisyn Moran and Jesmin Pervin and Aminur Rahman and Monjur Rahman and Sharifa Yeasmin and Hosneara Begum and Harunor Rashid and Mohammad Yunus and Daniel Hruschka and Arifeen, {Shams E.} and Streatfield, {Peter K.} and Lynn Sibley and Abbas Bhuiya and Marge Koblinsky",
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T2 - Recent experiences from Matlab, Bangladesh

AU - Rahman, Anisur

AU - Moran, Allisyn

AU - Pervin, Jesmin

AU - Rahman, Aminur

AU - Rahman, Monjur

AU - Yeasmin, Sharifa

AU - Begum, Hosneara

AU - Rashid, Harunor

AU - Yunus, Mohammad

AU - Hruschka, Daniel

AU - Arifeen, Shams E.

AU - Streatfield, Peter K.

AU - Sibley, Lynn

AU - Bhuiya, Abbas

AU - Koblinsky, Marge

PY - 2011

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