Article type
Abstract
Introduction:
Appropriate perinatal care provision and utilization is crucial to improve maternal and newborn survival and take a step closer to meeting Sustainable Development Goal 3. Perinatal regionalization was defined by WHO's Regional Office for Europe as a method that rationalizes existing healthcare services to ensure that each pregnant woman and newborn infant is cared for in an appropriate facility. It aims to provide comprehensive healthcare services to pregnant women and newborns to ensure equitable care based on their needs within a geographical area. Perinatal regionalization is a strategy aimed at organizing and distributing perinatal services to ensure that pregnant women and newborns receive appropriate and specialized care based on the level of risk or complexity of their medical conditions. Ensuring the availability of healthcare infrastructure and skilled personnel can potentially help improve maternal and neonatal outcomes globally and in resource-limited settings.
Methods:
A systematic review of the effectiveness of perinatal regionalization and the effectiveness of facility-based interventions to improve postnatal care coverage and outcomes was conducted. The search was conducted in relevant databases and a meta-analysis was conducted on Review Manager 5.4. We conducted sub-group analyses for evidence from low- and middle-income countries (LMICs).
Results:
Implementation of regionalization significantly decreased facility maternal mortality rates in LMIC subgroups (OR:0.55;95%CI:0.47-0.64; 2 studies), decreased stillbirth rates (OR:0.64;95%CI:0.43-0.96; 3 studies), decreased stillbirth rates in LMIC subgroups (OR:0.63;95%CI:0.40-0.98; 2 studies) and decreased neonatal mortality (OR:0.16;95%CI:0.10-0.24; 2 studies). Institutional delivery rates significantly increased (RR:1.42;95%CI:1.25-1.62; 3 studies) and LMIC subgroup analysis also showed increased institutional delivery rates (RR:1.43;95%CI:1.24-1.64; 2 studies).
Transport-related interventions significantly decreased maternal mortality (OR:0.55;95%CI:0.40-0.74; 1 study) and improved postnatal care coverage (OR:6.89;95%CI:5.15-9.21; 1 study). Telemedicine improved postnatal care coverage significantly in LMIC subgroups (RR:2.25;95%CI:1.36-3.70; 3 studies). Capacity-building interventions significantly decreased maternal mortality in LMIC subgroups (OR 0.64;95%CI:0.48-0.84; 10 studies), decreased neonatal mortality (OR:0.74;95%CI:0.56-0.96; 6 studies), decreased neonatal mortality in LMIC subgroups (OR:0.65;95%CI:0.55-0.77; 5 studies), and decreased stillbirth rates in LMIC subgroups (OR:0.71;95%CI:0.62-0.82; 4 studies).
Conclusion:
Perinatal regionalization and facility-based interventions positively impact maternal and neonatal outcomes, but a better understanding of optimal interventions is needed through comprehensive trials in multiple settings.
Appropriate perinatal care provision and utilization is crucial to improve maternal and newborn survival and take a step closer to meeting Sustainable Development Goal 3. Perinatal regionalization was defined by WHO's Regional Office for Europe as a method that rationalizes existing healthcare services to ensure that each pregnant woman and newborn infant is cared for in an appropriate facility. It aims to provide comprehensive healthcare services to pregnant women and newborns to ensure equitable care based on their needs within a geographical area. Perinatal regionalization is a strategy aimed at organizing and distributing perinatal services to ensure that pregnant women and newborns receive appropriate and specialized care based on the level of risk or complexity of their medical conditions. Ensuring the availability of healthcare infrastructure and skilled personnel can potentially help improve maternal and neonatal outcomes globally and in resource-limited settings.
Methods:
A systematic review of the effectiveness of perinatal regionalization and the effectiveness of facility-based interventions to improve postnatal care coverage and outcomes was conducted. The search was conducted in relevant databases and a meta-analysis was conducted on Review Manager 5.4. We conducted sub-group analyses for evidence from low- and middle-income countries (LMICs).
Results:
Implementation of regionalization significantly decreased facility maternal mortality rates in LMIC subgroups (OR:0.55;95%CI:0.47-0.64; 2 studies), decreased stillbirth rates (OR:0.64;95%CI:0.43-0.96; 3 studies), decreased stillbirth rates in LMIC subgroups (OR:0.63;95%CI:0.40-0.98; 2 studies) and decreased neonatal mortality (OR:0.16;95%CI:0.10-0.24; 2 studies). Institutional delivery rates significantly increased (RR:1.42;95%CI:1.25-1.62; 3 studies) and LMIC subgroup analysis also showed increased institutional delivery rates (RR:1.43;95%CI:1.24-1.64; 2 studies).
Transport-related interventions significantly decreased maternal mortality (OR:0.55;95%CI:0.40-0.74; 1 study) and improved postnatal care coverage (OR:6.89;95%CI:5.15-9.21; 1 study). Telemedicine improved postnatal care coverage significantly in LMIC subgroups (RR:2.25;95%CI:1.36-3.70; 3 studies). Capacity-building interventions significantly decreased maternal mortality in LMIC subgroups (OR 0.64;95%CI:0.48-0.84; 10 studies), decreased neonatal mortality (OR:0.74;95%CI:0.56-0.96; 6 studies), decreased neonatal mortality in LMIC subgroups (OR:0.65;95%CI:0.55-0.77; 5 studies), and decreased stillbirth rates in LMIC subgroups (OR:0.71;95%CI:0.62-0.82; 4 studies).
Conclusion:
Perinatal regionalization and facility-based interventions positively impact maternal and neonatal outcomes, but a better understanding of optimal interventions is needed through comprehensive trials in multiple settings.