title: Integration of antenatal care services with health programmes in low- and middle-income countries: systematic review.
abstract: BACKGROUND
  Antenatal care (ANC) presents a potentially valuable platform for integrated delivery of additional health services for pregnant women-services that are vital to reduce the persistently high rates of maternal and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited evidence on the impact of integrating health services with ANC to guide policy. This review assesses the impact of integration of postnatal and other health services with ANC on health services uptake and utilisation, health outcomes and user experience of care in LMICs.
  
  
  METHODS
  Cochrane Library, MEDLINE, Embase, CINAHL Plus, POPLINE and Global Health were searched for studies that compared integrated models for delivery of postnatal and other health services with ANC to non-integrated models. Risk of bias of included studies was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) criteria and the Newcastle-Ottawa Scale, depending on the study design. Due to high heterogeneity no meta-analysis could be conducted. Results are presented narratively.
  
  
  RESULTS
  12 studies were included in the review. Limited evidence, with moderate- to high-risk of bias, suggests that integrated service delivery results in improved uptake of essential health services for women, earlier initiation of treatment, and better health outcomes. Women also reported improved satisfaction with integrated services.
  
  
  CONCLUSIONS
  The reported evidence is largely based on non-randomised studies with poor generalizability, and therefore offers very limited policy guidance. More rigorously conducted and geographically diverse studies are needed to better ascertain and quantify the health and economic benefits of integrating health services with ANC.
authors.affiliation: Technopolis Group, Amsterdam, the Netherlands.
authors.forename: Thyra E
authors.initials: TE
authors.lastname: de Jongh
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Ipek
authors.initials: I
authors.lastname: Gurol-Urganci
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston MA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Allen
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston MA, USA.
authors.forename: Nina Jiayue
authors.initials: NJ
authors.lastname: Zhu
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston MA, USA.
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
mesh_terms: D000328:Adult; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008428:Maternal Mortality; D011203:Poverty / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration* / Q000706:statistics & numerical data*