title: A systematic review of essential obstetric and newborn care capacity building in rural sub-Saharan Africa.
abstract: BACKGROUND
  Progress in maternal survival in sub-Saharan Africa has been poor since the Millennium Declaration.
  
  
  OBJECTIVE
  This systematic review aims to investigate the presence and rigour of evidence for effective capacity building for Essential Obstetric and Newborn Care (EONC) to reduce maternal mortality in rural, sub-Saharan Africa, where maternal mortality ratios are highest globally.
  
  
  METHODS
  MEDLINE (1990-January 2014), EMBASE (1990-January 2014), and the Cochrane Library were included in our search. Key developing world issues of The Lancet and the British Journal of Obstetrics and Gynaecology, African Ministry of Health websites, and the WHO reproductive health library were searched by hand.
  
  
  METHODS
  Studies investigating essential obstetric and newborn care packages in basic and comprehensive care facilities, at community and institutional level, in rural sub-Saharan Africa were included. Studies were included if they reported on healthcare worker performance, access to care, community behavioural change, and emergency obstetric and newborn care.
  
  
  METHODS
  Data were extracted and all relevant studies independently appraised using structured abstraction and appraisal tools.
  
  
  RESULTS
  There is moderate evidence to support the training of healthcare workers of differing cadres in the provision of emergency obstetric and newborn services to reduce institutional maternal mortality and case-fatality rates in rural sub-Saharan Africa. Community schemes that sensitise and enable access to maternal health services result in a modest rise in facility birth and skilled birth attendance in this rural setting.
  
  
  CONCLUSIONS
  Essential Obstetric and Newborn Care has merit as an intervention package to reduce maternal mortality in rural sub-Saharan Africa.
authors.affiliation: Department of Obstetrics and Gynaecology, Mayo Medical Academy, National University of Ireland Galway at Mayo General Hospital, Castlebar, Ireland; Friends of Londiani, Londiani, Kenya.
authors.forename: G M
authors.initials: GM
authors.lastname: Ni Bhuinneain
authors.forename: F P
authors.initials: FP
authors.lastname: McCarthy
mesh_terms: D017954:Africa South of the Sahara; D057191:Capacity Building; D006297:Health Services Accessibility; D006801:Humans; D007224:Infant Care; D007231:Infant, Newborn; D008428:Maternal Mortality; D009774:Obstetrics / Q000193:education / Q000458:organization & administration; D019035:Rural Health Services
keywords: Essential obstetric and newborn care package; facility birth; maternal mortality; perinatal indicators; rural sub-Saharan Africa