Maternal marital status and birth outcomes: a systematic review and meta-analyses.

Systematically review risks of an infant being born with low birth weight (LBW), preterm birth (PTB) or small for gestational age (SGA) among married and unmarried women. Medline, Embase, CINAHL, and bibliographies of identified articles were searched for English language studies. Studies reporting birth outcomes of married and unmarried (single and cohabitant) were included. Two reviewers independently collected data and assessed the quality of the studies for biases in sample selection, exposure assessment, confounder, analytical, outcome assessments, and attrition. Meta-analyses were performed using random effect model for both unadjusted and adjusted data and odds ratio (OR), and 95% confidence interval (CI) were calculated. Twenty-one studies of low to moderate risk of bias were included. Compared to married mothers unadjusted odds of (a) LBW was increased among unmarried (OR 1.46, 95%CI 1.25-1.71), single (OR 1.65, 95%CI 1.44-1.88) and cohabitating (OR 1.29, 95%CI 1.25-1.32) mothers; (b) PTB was increased among unmarried (OR 1.22, 95%CI 1.14-1.31), single (OR 1.54, 95%CI 1.39-1.72) and cohabitating (OR 1.15, 95%CI 1.08-1.23) mothers and (c) SGA birth was increased among unmarried (OR 1.45, 95%CI 1.32-1.61), single (OR 1.70, 95%CI 1.47-1.97) and cohabitating (OR 1.36, 95%CI 1.30-1.42) mothers. Meta-analyses of adjusted odds estimates confirmed these findings at marginally lower odds. Maternal unmarried status is associated with an increased risk of LBW, PTB and SGA births.

Management of newborn infections in primary care settings: a review of the evidence and implications for policy?

BACKGROUND: Long-term, sustainable programs to address high incidence and death rates from neonatal infections are required for improving child survival. There is an urgent need to define the role of community-based management for neonates with serious bacterial infections--both at home and at first-level facilities. METHODS: We reviewed available evidence for community-based antibiotic management strategies for serious neonatal infections. RESULTS: Nine distinct studies contributing data for community-based management of neonatal pneumonia and sepsis were identified. In a pooled analysis of 5 controlled trials of community-based management of neonatal pneumonia (4 using cotrimoxazole, 1 ampicillin, or penicillin), all-cause neonatal mortality showed 27% [95% confidence interval (CI): 18%-35%] reduction and pneumonia-specific mortality, 42% (95% CI: 22%-57%). Substantial reductions in neonatal mortality have been demonstrated in a nonrandomized controlled study in rural India (62% reduction, P < 0.001) and in a cluster randomized trial in rural Bangladesh (34% reduction, 95% CI: 7%-53%). Reduced case fatalities (0%-3%) with community-based management of neonatal sepsis were observed in 2 small uncontrolled studies from India and Guatemala and a recent randomized trial from Pakistan. CONCLUSIONS: Although methodological limitations preclude estimating the precise contribution of antibiotics toward neonatal mortality reduction in community settings in low income countries, available data suggest substantial benefit of case management approaches using antibiotics for neonatal sepsis in such settings.

Alma-Ata: Rebirth and Revision 6 Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make?

Several recent reviews of maternal, newborn, and child health (MNCH) and mortality have emphasised that a large range of interventions are available with the potential to reduce deaths and disability. The emphasis within MNCH varies, with skilled care at facility levels recommended for saving maternal lives and scale-up of community and household care for improving newborn and child survival. Systematic review of new evidence on potentially useful interventions and delivery strategies identifies 37 key promotional, preventive, and treatment interventions and strategies for delivery in primary health care. Some are especially suitable for delivery through community support groups and health workers, whereas others can only be delivered by linking community-based strategies with functional first-level referral facilities. Case studies of MNCH indicators in Pakistan and Uganda show how primary health-care interventions can be used effectively. Inclusion of evidence-based interventions in MNCH programmes in primary health care at pragmatic coverage in these two countries could prevent 20-30% of all maternal deaths (up to 32% with capability for caesarean section at first-level facilities), 20-21% of newborn deaths, and 29-40% of all postneonatal deaths in children aged less than 5 years. Strengthening MNCH at the primary health-care level should be a priority for countries to reach their Millennium Development Goal targets for reducing maternal and child mortality.