Abstracts

Effectiveness of strategies incorporating training and support of traditional birth attendants on perinatal and maternal mortality: meta-analysis

Amie Wilson and her colleagues assessed the effectiveness of strategies incorporating training and support of traditional birth attendants on the outcomes of perinatal, neonatal, and maternal death in developing countries using a systematic review with meta-analysis.

The authors selected randomised and non-randomised controlled studies with outcomes of perinatal, neonatal, and maternal mortality. Two independent reviewers undertook data extraction. Relative risks were pooled separately for the randomised and non-randomised controlled studies, using a random effects model.

The authors identified 6 cluster randomised controlled trials (N=138 549) and 7 non-randomised controlled studies (N=72 225) that investigated strategies incorporating training and support of traditional birth attendants. All 6 randomised controlled trials found a reduction in adverse perinatal outcomes; our meta-analysis showed significant reductions in perinatal death (relative risk 0.76, 95% confidence interval 0.64 - 0.88, p<0.001; number needed to treat 35, 24 - 70) and neonatal death (0.79, 0.69 - 0.88, p<0.001; 98, 66 - 170). Meta-analysis of the non-randomised studies also showed a significant reduction in perinatal mortality (0.70, 0.57 - 0.84, p<0.001; 48, 32 - 96) and neonatal mortality (0.61, 0.48 - 0.75, p<0.001; 96, 65 - 168). Six studies reported on maternal mortality and our meta-analysis showed a non-significant reduction (three randomised trials, relative risk 0.79, 0.53 - 1.05, p=0.12; three non-randomised studies, 0.80, 0.44 - 1.15, p=0.26).

The conclusion was that perinatal and neonatal deaths are significantly reduced with strategies incorporating training and support of traditional birth attendants.

Wilson A, et al. BMJ 2011;343:d7102.