title: Effectiveness of strategies incorporating training and support of traditional birth attendants on perinatal and maternal mortality: meta-analysis.
abstract: OBJECTIVE
  To assess the effectiveness of strategies incorporating training and support of traditional birth attendants on the outcomes of perinatal, neonatal, and maternal death in developing countries.
  
  
  METHODS
  Systematic review with meta-analysis.
  
  
  METHODS
  Medline, Embase, the Allied and Complementary Medicine database, British Nursing Index, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, BioMed Central, PsycINFO, Latin American and Caribbean Health Sciences Literature database, African Index Medicus, Web of Science, Reproductive Health Library, and Science Citation Index (from inception to April 2011), without language restrictions. Search terms were "birth attend*", "traditional midwife", "lay birth attendant", "dais", and "comadronas".  Review methods We selected randomised and non-randomised controlled studies with outcomes of perinatal, neonatal, and maternal mortality. Two independent reviewers undertook data extraction. We pooled relative risks separately for the randomised and non-randomised controlled studies, using a random effects model.
  
  
  RESULTS
  We identified six cluster randomised controlled trials (n=138 549) and seven non-randomised controlled studies (n=72 225) that investigated strategies incorporating training and support of traditional birth attendants. All six 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 to 0.88, P<0.001; number needed to treat 35, 24 to 70) and neonatal death (0.79, 0.69 to 0.88, P<0.001; 98, 66 to 170). Meta-analysis of the non-randomised studies also showed a significant reduction in perinatal mortality (0.70, 0.57 to 0.84, p<0.001; 48, 32 to 96) and neonatal mortality (0.61, 0.48 to 0.75, P<0.001; 96, 65 to 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 to 1.05, P=0.12; three non-randomised studies, 0.80, 0.44 to 1.15, P=0.26).
  
  
  CONCLUSIONS
  Perinatal and neonatal deaths are significantly reduced with strategies incorporating training and support of traditional birth attendants.
authors.affiliation: School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Amie
authors.initials: A
authors.lastname: Wilson
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Gallos
authors.forename: Nieves
authors.initials: N
authors.lastname: Plana
authors.forename: David
authors.initials: D
authors.lastname: Lissauer
authors.forename: Khalid S
authors.initials: KS
authors.lastname: Khan
authors.forename: Javier
authors.initials: J
authors.lastname: Zamora
authors.forename: Christine
authors.initials: C
authors.lastname: MacArthur
authors.forename: Arri
authors.initials: A
authors.lastname: Coomarasamy
mesh_terms: D003906:Developing Countries; D005260:Female; D014943:Global Health; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D008880:Midwifery / Q000193:education; D054238:Perinatal Mortality; D011247:Pregnancy