Perinatal interventions and survival in resource-poor settings: which work, which don't, which have the jury out?
Perinatal conditions make the largest contribution to the burden of disease in low-income countries. Although postneonatal mortality rates have declined, stillbirth and early neonatal mortality rates remain high in many countries in Africa and Asia, and there is a concentration of mortality around the time of birth. Our article begins by considering differences in the interpretation of 'intervention' to improve perinatal survival. We identify three types of


METHODS
a single action, a collection of actions delivered in a package and a broader social or system approach. We use this classification to summarise the findings of recent systematic reviews and meta-analyses. After describing the growing evidence base for the effectiveness of community-based perinatal care, we discuss current concerns about integration: of women's and children's health programmes, of community-based and institutional care, and of formal and informal sector human resources. We end with some thoughts on the complexity of choices confronting women and their families in low-income countries, particularly in view of the growth in non-government and private sector healthcare.
Osrin
David
D
Centre for International Health and Development, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK. d.osrin@ich.ucl.ac.uk
Prost
Audrey
A
D003153:Community Health Services / Q000379:methods; D003695:Delivery of Health Care / Q000379:methods; D003906:Developing Countries; D019317:Evidence-Based Medicine / Q000379:methods; D014943:Global Health; D006801:Humans; D007231:Infant, Newborn; D008507:Medically Underserved Area; D018743:Perinatal Care / Q000379:methods*; D054238:Perinatal Mortality; D017150:Public Sector