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Targeted Interventions for Improved Equity in Maternal and Child Health in Low- and Middle-Income Settings: A Systematic Review and Meta-Analysis

Author

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  • Mats Målqvist
  • Beibei Yuan
  • Nadja Trygg
  • Katarina Selling
  • Sarah Thomsen

Abstract

Background: Targeted interventions to improve maternal and child health is suggested as a feasible and sometimes even necessary strategy to reduce inequity. The objective of this systematic review was to gather the evidence of the effectiveness of targeted interventions to improve equity in MDG 4 and 5 outcomes. Methods and Findings: We identified primary studies in all languages by searching nine health and social databases, including grey literature and dissertations. Studies evaluating the effect of an intervention tailored to address a structural determinant of inequity in maternal and child health were included. Thus general interventions targeting disadvantaged populations were excluded. Outcome measures were limited to indicators proposed for Millennium Development Goals 4 and 5. We identified 18 articles, whereof 15 evaluated various incentive programs, two evaluated a targeted policy intervention, and only one study evaluated an intervention addressing a cultural custom. Meta-analyses of the effectiveness of incentives programs showed a pooled effect size of RR 1.66 (95% CI 1.43–1.93) for antenatal care attendance (four studies with 2,476 participants) and RR 2.37 (95% CI 1.38–4.07) for health facility delivery (five studies with 25,625 participants). Meta-analyses were not performed for any of the other outcomes due to scarcity of studies. Conclusions: The targeted interventions aiming to improve maternal and child health are mainly limited to addressing economic disparities through various incentive schemes like conditional cash transfers and voucher schemes. This is a feasible strategy to reduce inequity based on income. More innovative action-oriented research is needed to speed up progress in maternal and child survival among the most disadvantaged populations through interventions targeting the underlying structural determinants of inequity.

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  • Mats Målqvist & Beibei Yuan & Nadja Trygg & Katarina Selling & Sarah Thomsen, 2013. "Targeted Interventions for Improved Equity in Maternal and Child Health in Low- and Middle-Income Settings: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-10, June.
    • Handle: RePEc:plo:pone00:0066453
    DOI: 10.1371/journal.pone.0066453
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    1. Sudha Narayanan & Shree Saha, 2020. "Take home rations (THR) and cash transfers for maternal and child nutrition: A Synthesis of evidence in India," Indira Gandhi Institute of Development Research, Mumbai Working Papers 2020-039, Indira Gandhi Institute of Development Research, Mumbai, India.
    2. Tania Jahir & Peter J. Winch & Elli Leontsini & Sharon T. Hwang & Farzana Yeasmin & Khobair Hossain & Jyoti Bhushan Das & Ruhul Amin & Tarique Md. Nurul Huda & Jesmin Sultana & Rizwana Khan & Fahmida , 2021. "Success Factors for Community Health Workers in Implementing an Integrated Group-Based Child Development Intervention in Rural Bangladesh," IJERPH, MDPI, vol. 18(15), pages 1-15, July.
    3. Sochas, Laura, 2019. "Women who break the rules: Social exclusion and inequities in pregnancy and childbirth experiences in Zambia," Social Science & Medicine, Elsevier, vol. 232(C), pages 278-288.
    4. Mats Målqvist & Dinh Phuong Thi Hoa & Lars-Åke Persson & Katarina Ekholm Selling, 2015. "Effect of Facilitation of Local Stakeholder Groups on Equity in Neonatal Survival; Results from the NeoKIP Trial in Northern Vietnam," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-10, December.
    5. Camila Perera & Shivit Bakrania & Alessandra Ipince & Zahrah Nesbitt‐Ahmed & Oluwaseun Obasola & Dominic Richardson, 2021. "PROTOCOL: Impact of social protection on gender equality in low‐ and middle‐income countries: A systematic review of reviews," Campbell Systematic Reviews, John Wiley & Sons, vol. 17(2), June.
    6. McKinnon, Britt & Harper, Sam & Kaufman, Jay S., 2015. "Who benefits from removing user fees for facility-based delivery services? Evidence on socioeconomic differences from Ghana, Senegal and Sierra Leone," Social Science & Medicine, Elsevier, vol. 135(C), pages 117-123.
    7. Shahinoor Akter & Kate Davies & Jane Louise Rich & Kerry Jill Inder, 2019. "Indigenous women’s access to maternal healthcare services in lower- and middle-income countries: a systematic integrative review," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(3), pages 343-353, April.
    8. Camila Perera & Shivit Bakrania & Alessandra Ipince & Zahrah Nesbitt‐Ahmed & Oluwaseun Obasola & Dominic Richardson & Jorinde Van de Scheur & Ruichuan Yu, 2022. "Impact of social protection on gender equality in low‐ and middle‐income countries: A systematic review of reviews," Campbell Systematic Reviews, John Wiley & Sons, vol. 18(2), June.
    9. Antonio P Ramos & Martin J Flores & Robert E Weiss, 2020. "Leave no child behind: Using data from 1.7 million children from 67 developing countries to measure inequality within and between groups of births and to identify left behind populations," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-23, October.
    10. Sarah Alkenbrack & Michael Chaitkin & Wu Zeng & Taryn Couture & Suneeta Sharma, 2015. "Did Equity of Reproductive and Maternal Health Service Coverage Increase during the MDG Era? An Analysis of Trends and Determinants across 74 Low- and Middle-Income Countries," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-22, September.

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