title: The effectiveness of community-based loan funds for transport during obstetric emergencies in developing countries: a systematic review.
abstract: OBJECTIVE
  Scarcity and costs of transport have been implicated as key barriers to accessing care when obstetric emergencies occur in community settings. Community-based loans have been used to increase utilization of health facilities and potentially reduce maternal mortality by providing funding at community level to provide emergency transport. This review aimed to provide evidence of the effect of community-based loan funds on utilization of health facilities and reduction of maternal mortality in developing countries.
  
  
  METHODS
  Electronic databases of published literature and websites were searched for relevant literature using a pre-defined set of search terms, inclusion and exclusion criteria. Screening of titles, abstracts and full-text articles were done by at least two reviewers independently. Quality assessment was carried out on the selected papers. Data related to deliveries and obstetric complications attended at facilities, maternal deaths and live births were extracted to measure and compare the effects of community-based loan funds using odds ratios (ORs) and reductions in maternal mortality ratio. Forest plots are presented where possible.
  
  
  RESULTS
  The results of the review show that groups where community-based loan funds were implemented (alongside other interventions) generally recorded increases in utilization of health facilities for deliveries, with ORs of 3.5 (0.97-15.48) and 3.55 (1.56-8.05); and an increase in utilization of emergency obstetric care with ORs of 2.22 (0.51-10.38) and 3.37 (1.78-6.37). Intervention groups also experienced a positive effect on met need for complications and a reduction in maternal mortality.
  
  
  CONCLUSIONS
  There is some evidence to suggest that community-based loan funds as part of a multifaceted intervention have positive effects. Conclusions are limited by challenges of study design and bias. Further studies which strengthen the evidence of the effects of loan funds, and mechanism for their functionality, are recommended.
authors.affiliation: Doctoral Researcher, School of Health & Social Care, Duke of Kent Building, University of Surrey, Guildford, Surrey, UK. GU2 7XH, c.nwolise@surrey.ac.uk.
authors.forename: Chidiebere Hope
authors.initials: CH
authors.lastname: Nwolise
authors.affiliation: Immpact, School of Medicine & Dentistry, University of Aberdeen, 2nd Floor, Health Sciences Building, Foresterhill, Aberdeen, UK. AB25 2ZD.
authors.forename: Julia
authors.initials: J
authors.lastname: Hussein
authors.affiliation: Doctoral Researcher, Immpact, School of Medicine & Dentistry, University of Aberdeen, 2nd Floor, Health Sciences Building, Foresterhill, Aberdeen, UK. AB25 2ZD.
authors.forename: Lovney
authors.initials: L
authors.lastname: Kanguru
authors.affiliation: Immpact, School of Medicine & Dentistry, University of Aberdeen, 2nd Floor, Health Sciences Building, Foresterhill, Aberdeen, UK. AB25 2ZD and.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Bell
authors.affiliation: Independent Researcher, 1179 Church Street, D, Decatur, GA 30030, USA.
authors.forename: Purvi
authors.initials: P
authors.lastname: Patel
mesh_terms: D016208:Databases, Factual; D036861:Delivery, Obstetric; D003906:Developing Countries; D004632:Emergency Medical Services; D005378:Financial Support; D006801:Humans; D014187:Transportation of Patients / Q000191:economics*
keywords: Maternal mortality; community; developing countries; emergency obstetric care; interventions; loan funds; review; transport