title: Strategies for improving health care seeking for maternal and newborn illnesses in low- and middle-income countries: a systematic review and meta-analysis.
abstract: BACKGROUND
  Lack of appropriate health care seeking for ill mothers and neonates contributes to high mortality rates. A major challenge is the appropriate mix of strategies for creating demand as well as provision of services.
  
  
  METHODS
  Systematic review and meta-analysis of experimental studies (last search: Jan 2015) to assess the impact of different strategies to improve maternal and neonatal health care seeking in low- and middle-income countries (LMIC).
  
  
  RESULTS
  Fifty-eight experimental [randomized controlled trials (RCTs), non-RCTs, and before-after studies] with 310,652 participants met the inclusion criteria. Meta-analyses from 29 RCTs with a range of different interventions (e.g. mobilization, home visitation) indicated significant improvement in health care seeking for neonatal illnesses when compared with standard/no care [risk ratio (RR) 1.40; 95 confidence interval (CI): 1.17-1.68, 9 studies, n=30,572], whereas, no impact was seen on health care seeking for maternal illnesses (RR 1.06; 95% CI: 0.92-1.22, 5 studies, n=15,828). These interventions had a significant impact on reducing stillbirths (RR 0.82; 95% CI: 0.73-0.93, 11 studies, n=176,683), perinatal deaths (RR 0.84; 95% CI: 0.77-0.90, 15 studies, n=279,618), and neonatal mortality (RR 0.80; 95% CI: 0.72-0.89, 20 studies, n=248,848). On GRADE approach, evidence was high quality except for the outcome of maternal health care seeking, which was moderate.
  
  
  CONCLUSIONS
  Community-based interventions integrating strategies such as home visiting and counseling can help to reduce fetal and neonatal mortality in LMIC.
authors.affiliation: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia; zohra.lassi@adelaide.edu.au.
authors.forename: Zohra S
authors.initials: ZS
authors.lastname: Lassi
authors.affiliation: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia.|Women's and Children's Health Research Institute, The University of Adelaide, Adelaide, Australia.
authors.forename: Philippa F
authors.initials: PF
authors.lastname: Middleton
authors.affiliation: Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.|Centre of Excellence for Women and Child Health, The Aga Khan University, Karachi, Pakistan.
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, Australia.|Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Caroline
authors.initials: C
authors.lastname: Crowther
mesh_terms: D003153:Community Health Services; D005260:Female; D006792:House Calls; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy*; D008427:Maternal Health Services; D010342:Patient Acceptance of Health Care; D011181:Postnatal Care / Q000379:methods*; D011203:Poverty; D011247:Pregnancy
keywords: developing countries; health care seeking; low- and middle-income countries; maternal health; neonatal health; neonatal mortality; perinatal mortality