Safe motherhood intervention studies in Africa: A review

Objective: To review the findings of safe motherhood intervention studies c onducted in African settings. Data sources: Published literature regarding interventions designed to redu ce maternal mortality in African settings. Study selection: Studies conducted in sub-Saharan Africa to assess the effe cts of interventions designed to reduce maternal mortality. Data extraction: Search of Medline database for the years 1988 to 1998 with additional manual search of references cited in Medline-referenced studies . Data synthesis: Few of the 34 intervention studies identified used a double -blind, randomized controlled trial design (4/34), or outcome measures dire ctly related to maternal mortality or maternal health (7/34). Six of the st udies produced reasonably convincing evidence of a positive effect on mater nal health outcomes. Of these, three showed that changes in delivery practi ces brought about improved maternal outcomes, two found that a combined int ervention consisting of upgrading of emergency obstetric services and commu nity education increased the number of major obstetric complications treate d, and one showed that a range of improvements in hospital equipment and ma nagement reduced facility-based maternal mortality ratios. No study sought to reduce maternal mortality associated with unsafe termination of pregnanc y. Conclusions: More than a decade after the launching of the Safe Motherhood Initiative, there exists little evidence regarding which interventions will reduce maternal mortality levels in African settings. Intervention studies conducted in Africa have identified several low-tech improvements in emerg ency obstetric services which improve maternal outcomes and deserve replica tion and testing in a variety of settings, Further operational research sho uld be conducted to identify and test other promising safe motherhood inter ventions, in particular interventions designed to reduce the important prop ortion of maternal mortality associated with unsafe termination of pregnanc y.