Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review
Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review
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DOI：
10.1186/1471-2393-14-243
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发表时间：
2014-07-22
影响因子：
3.1
通讯作者：
Schellenberg, Joanna
中科院分区：
文献类型：
--
作者：
Mangham-Jefferies, Lindsay;Pitt, Catherine;Schellenberg, Joanna
背景资料：全世界每年有近300万新生儿在出生后28天内死亡，260万婴儿死产，28.7万妇女死于妊娠和分娩并发症。针对母亲和新生儿的有效和具有成本效益的干预措施和行为是存在的，但在低收入和中等收入国家，这些措施和行为的覆盖面仍然不足，而绝大多数死亡发生在这些国家。需要成本效益的战略，以增加拯救生命的孕产妇和新生儿的干预措施和行为的覆盖面在resource-constrainedsettings.Methods：进行了系统的审查的成本效益的战略，以改善孕产妇和新生儿保健的需求和供应在低收入和中低收入国家。自1990年以来发表的同行评议和灰色文献检索使用书目数据库，选定的组织的网站，以及相关研究和评论的参考文献列表。如果出版物报告的行为或卫生系统战略旨在改善怀孕、分娩或新生儿期护理的利用或提供，报告其成本效益，并在一个或多个低收入或中低收入国家制定，则有资格列入。出版物的质量使用综合卫生经济评价报告标准声明进行评估。增量成本每生命年保存和每残疾调整生命年避免进行了比较，人均国内生产总值。结果：48出版物被确定，其中报告了43个独立的研究。16个被认为是高质量的。确定了共同的主题，并提出了与持续护理和卫生系统水平有关的战略。有相当有力的证据表明，利用妇女团体、利用社区保健工作者和传统助产士提供家庭新生儿护理、在常规产前护理中增加服务、以设施为基础的质量改进倡议以加强对护理标准的遵守以及在妇产医院推广母乳喂养具有成本效益。其他战略报告的成本效益的措施，有限的comparatives.Conclusion：需求和供应方的战略，以改善孕产妇和新生儿的保健可以是具有成本效益的，虽然证据是有限的缺乏高质量的研究和使用不同的成本效益的措施。
Background: Each year almost 3 million newborns die within the first 28 days of life, 2.6 million babies are stillborn, and 287,000 women die from complications of pregnancy and childbirth worldwide. Effective and cost-effective interventions and behaviours for mothers and newborns exist, but their coverage remains inadequate in low-and middle-income countries, where the vast majority of deaths occur. Cost-effective strategies are needed to increase the coverage of life-saving maternal and newborn interventions and behaviours in resource-constrained settings.Methods: A systematic review was undertaken on the cost-effectiveness of strategies to improve the demand and supply of maternal and newborn health care in low-income and lower-middle-income countries. Peer-reviewed and grey literature published since 1990 was searched using bibliographic databases, websites of selected organizations, and reference lists of relevant studies and reviews. Publications were eligible for inclusion if they report on a behavioural or health systems strategy that sought to improve the utilization or provision of care during pregnancy, childbirth or the neonatal period; report on its cost-effectiveness; and were set in one or more low-income or lower-middle-income countries. The quality of the publications was assessed using the Consolidated Health Economic Evaluation Reporting Standards statement. Incremental cost per life-year saved and per disability-adjusted life-year averted were compared to gross domestic product per capita.Results: Forty-eight publications were identified, which reported on 43 separate studies. Sixteen were judged to be of high quality. Common themes were identified and the strategies were presented in relation to the continuum of care and the level of the health system. There was reasonably strong evidence for the cost-effectiveness of the use of women's groups, home-based newborn care using community health workers and traditional birth attendants, adding services to routine antenatal care, a facility-based quality improvement initiative to enhance compliance with care standards, and the promotion of breastfeeding in maternity hospitals. Other strategies reported cost-effectiveness measures that had limited comparability.Conclusion: Demand and supply-side strategies to improve maternal and newborn health care can be cost-effective, though the evidence is limited by the paucity of high quality studies and the use of disparate cost-effectiveness measures.