title: Effective non-drug interventions for improving outcomes and quality of maternal health care in sub-Saharan Africa: a systematic review.
abstract: Many interventions have been implemented to improve maternal health outcomes in sub-Saharan Africa (SSA). Currently, however, systematic information on the effectiveness of these interventions remains scarce. We conducted a systematic review of published evidence on non-drug interventions that reported effectiveness in improving outcomes and quality of care in maternal health in SSA.
  
  
  
  African Journals Online, Bioline, MEDLINE, Ovid, Science Direct, and Scopus databases were searched for studies published in English between 2000 and 2015 and reporting on the effectiveness of interventions to improve quality and outcomes of maternal health care in SSA. Articles focusing on interventions that involved drug treatments, medications, or therapies were excluded. We present a narrative synthesis of the reported impact of these interventions on maternal morbidity and mortality outcomes as well as on other dimensions of the quality of maternal health care (as defined by the Institute of Medicine 2001 to comprise safety, effectiveness, efficiency, timeliness, patient centeredness, and equitability).
  
  
  
  Seventy-three studies were included in this review. Non-drug interventions that directly or indirectly improved quality of maternal health and morbidity and mortality outcomes in SSA assumed a variety of forms including mobile and electronic health, financial incentives on the demand and supply side, facility-based clinical audits and maternal death reviews, health systems strengthening interventions, community mobilization and/or peer-based programs, home-based visits, counseling and health educational and promotional programs conducted by health care providers, transportation and/or communication and referrals for emergency obstetric care, prevention of mother-to-child transmission of HIV, and task shifting interventions. There was a preponderance of single facility and community-based studies whose effectiveness was difficult to assess.
  
  
  
  Many non-drug interventions have been implemented to improve maternal health care in SSA. These interventions have largely been health facility and/or community based. While the evidence on the effectiveness of interventions to improve maternal health is varied, study findings underscore the importance of implementing comprehensive interventions that strengthen different components of the health care systems, both in the community and at the health facilities, coupled with a supportive policy environment.
  
  
  
  PROSPERO CRD42015023750.
authors.affiliation: African Population Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P. O. Box 10787, Nairobi, 00100, Kenya. fwekesah@aphrc.org.|Julius Global Health, Julius Center for Health Sciences and Primary Care, Utrecht Medical Center, Utrecht Huispost Str. 6.131, P.O. Box 85500, 3508 GA, Utrecht, Netherlands. fwekesah@aphrc.org.
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Wekesah
authors.affiliation: African Population Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P. O. Box 10787, Nairobi, 00100, Kenya.|Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
authors.forename: Chidozie E
authors.initials: CE
authors.lastname: Mbada
authors.affiliation: Department of Public Health, School of Public Health and Family Health, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi.|African Center for Public Health and Herbal Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Adamson S
authors.initials: AS
authors.lastname: Muula
authors.affiliation: African Population Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P. O. Box 10787, Nairobi, 00100, Kenya.
authors.forename: Caroline W
authors.initials: CW
authors.lastname: Kabiru
authors.affiliation: African Population Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P. O. Box 10787, Nairobi, 00100, Kenya.
authors.forename: Stella K
authors.initials: SK
authors.lastname: Muthuri
authors.affiliation: African Population Health Research Center, 2nd Floor, APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, P. O. Box 10787, Nairobi, 00100, Kenya.
authors.forename: Chimaraoke O
authors.initials: CO
authors.lastname: Izugbara
mesh_terms: D017954:Africa South of the Sahara; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data*
keywords: Effectiveness; Emergency obstetric care; Interventions; Maternal health care; Morbidity; Mortality; Quality; Review; Sub-Saharan Africa