Table 2 Characteristics of included studies

UNICEF [2]

Pakistan

Case Study

Community based services: In coordination with department of health and WHO.

UNICEF supports maternal and child healthcare services including provision of around-the-clock basic emergency obstetric services through skilled birth attendants. Community outreach workers/social mobilisers and health educators have conducted awareness sessions on infant and young child feeding, community-based management of acute malnutrition and hygiene education.

6,458 children were reached with lifesaving immunisations during a national immunisation campaign.

N.A

This is a case study of situation of armed conflict affected areas in Pakistan.

72,193 persons are benefitting from UNICEF supported provision of 255,000 l of safe drinking water per day

Aitken [6]

Afghanistan

Case Study

Community based services: Training of CHWs as part of the Basic Package of Health Services. This was sponsored by NGOs, UNAID and World Bank.

The Basic Package of Health Services consists of various aspects including facility and community based approaches. In this case study only CHW training has been discussed. Specifics on programme implementation or methodology used to collect data have not been mentioned in the report. The differences in skilled birth attendance and antenatal care three years after the introduction of CHWs in community are given.

Skilled birth attendance rose from 7 to 19 %. Antenatal care use increased from 8 to 32 %

N.A

This is a case study of situation of Afghanistan between 2003 and 2006 and how health parameters have changed with time. The paper describes the efforts of different organisations and their funding. Little information is available about the interventions used.

Miranda [10]

Guatemala

Pre-Post Surveys

Outreach service: Safe motherhood was advocated through a mobile healthcare unit in 23 rural frontier communities. The mobile team was responsible for training of community health workers, community education and the provision of maternal health services. The programme was carried out by Marie Stopes Mexico

Evaluation of the services provided by mobile unit was conducted using pre and post KAP surveys in 12 selected communities using a representative sample. Interviews were conducted with 388 indigenous men and women of reproductive age in the baseline survey in June 2001 and with 398 in the post-intervention survey in June 2003. Further details of the methodology are not available.

Prenatal and childbirth care by midwives increased significantly from 71 to 89 % (P = 0.00)

Please refer to Table three

This paper was presented in the RHRC conference proceeding in 2003. Only the abstract is available and details ofmethodology and results are not clear.

Marie Stopes Mexico is an NGO focusing care towards reproductive and maternal health.

Mullany [11]

Myanmar

Pre-post Surveys

Community based services: CHWs, TBAs and maternal health workers were trained for eight months and allowed to work in the community for two years.

Two-stage cluster-sampling surveys among married women of reproductive age (15–45 y) conducted before and after programme implementation enabled evaluation of changes in coverage of essential antenatal care interventions, attendance at birth by those trained to manage complications, postnatal care, and family planning services.

Skilled birth attendance increased from 5.1 to 48.7 %

Please refer to Table three

N.S

Wabulakombe [13]

Democratic Republic of the Congo

Unclear

Outreach services: A safe motherhood and family planning programme to reduce maternal and infant mortality was conducted after a survey to identify the healthcare needs of the community. Sponsored by Merlin charity.

Details of the methodology and analysis are not provided.

Antenatal consultation rate increased from 55 to 88 %. The proportion of safe deliveries conducted by the trained staff increased from 37 to 60 %. Maternal mortality decreased from 0.22 to 0.15 %

N.A

This paper was presented in the RHRC conference proceeding in 2003. Only the abstract is available and details on the methodology and results are not clear.

Programme activities included: Raising community awareness, making the health facilities operational, transferring skills to the district health team, changing the health-related behaviour of the population, providing drugs and equipment to health facilities

Casey [7]

Democratic Republic of the Congo

Case study

Facility based services: Evaluation of nine EmONC centres

Nine EmONC centres evaluated as providing inadequate healthcare were brought to attention of Ministry of Health. These centres were then supplied with resources and equipment.

No analysis was performed

N.A

N.S

UNICEF [5]

Afghanistan

Case Study

Community based services for health, nutrition and hygiene. UNICEF

Micronutrient supplementation, exclusive breastfeeding and complementary feeding. Children, women and communities displaced by emergencies will have improved access to maternal, infant and child health services at the community and facility levels. Measles vaccinations will be provided to all children up to 15 years of age and children under 5 will receive vitamin A supplementation.

The construction of 1,200 community water systems, including 1,100 borehole hand pumps and 100 small pipe water systems will provide access to safe drinking water for more than 30,000 families.

N.A

This project aimed to improve MNCH in Afghanistan

Rutta [12]

Tanzania

Descriptive cross sectional

Facility based services: Through a healthcare centre, community sensitisation to HIV, trainings of healthcare workers, voluntary counselling and HIV testing, infant feeding, counselling, and administration of Nevirapine were advocated.

Two year data from four antenatal clinics and two hospitals’ delivery registers was used for descriptive analysis.

92.3 % of the pregnant women who received counselling at these centres agreed to go through HIV screening. 93 % of the women tested positive for HIV agreed on Nevirapine. All of the infants of HIV positive mothers delivered were given Nevirapine soon after birth.

N.A

N.S

Main outcome measures include: HIV testing acceptance rates, percentage of women receiving post-test counselling, Nevirapine uptake, and HIV prevalence among pregnant women and their infants.

McNab [9] (publication year not clear)

Sudan

Case study

Facility based services: the setting up of an EmONC centre which allowed free of cost RH and maternal health services. This was sponsored by the Ministry of Health Sudan and the ARC.

The report describes how the EmONC centre was set up and how it could be of benefit to the community. No analysis or data collection was performed.

No analysis was performed

N.A

N.S

McGinn [8]

Liberia

Case study

Facility based services: American Refugee Committee procured and supplied obstetric equipment and drugs, recruited and trained national staff and upgraded three hospitals to provide comprehensive obstetric care, and six health centres to provide basic emergency obstetric care. In addition, ARC employed a Nigerian surgeon to work at the remote Grand Gedeh County Hospital, and trained surgical technicians.

Very short narrative of the implementation of this programme is given.

No analysis was performed

N.A

This programme was shut down due to increased conflicts in 2004 before the impact could be evaluated.

ARC set out to strengthen family planning and improve emergency obstetric care in Montserrado, Grand Gedeh and Sinoe counties.