title: Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014.
abstract: BACKGROUND
  Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014.
  
  
  METHODS
  PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period.
  
  
  RESULTS
  We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies.
  
  
  CONCLUSIONS
  The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence.
authors.affiliation: Department of Community Medicine, Faculty of Medicine, Kaduna State University, Kaduna, Nigeria. musakana77@yahoo.com.|EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal. musakana77@yahoo.com.
authors.forename: Musa Abubakar
authors.initials: MA
authors.lastname: Kana
authors.affiliation: Integrated Programme and Oversight Branch, Division for Operations, United Nations Office on Drugs and Crime, Abuja, Nigeria. hvdoctor@gmail.com.
authors.forename: Henry Victor
authors.initials: HV
authors.lastname: Doctor
authors.affiliation: EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal. barbarap@med.up.pt.|Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal. barbarap@med.up.pt.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Peleteiro
authors.affiliation: EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal. nlunet@med.up.pt.|Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal. nlunet@med.up.pt.
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
authors.affiliation: EPIUnit - Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal. hbarros@med.up.pt.|Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal. hbarros@med.up.pt.
authors.forename: Henrique
authors.initials: H
authors.lastname: Barros
mesh_terms: D002648:Child; D046688:Child Mortality; D002669:Child Welfare / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D006291:Health Policy; D006801:Humans; D007223:Infant; D007229:Infant Welfare / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D009549:Nigeria; D017063:Outcome Assessment, Health Care; D011247:Pregnancy