Strategies for improving health care seeking for maternal and newborn illnesses in low- and middle-income countries: A systematic review and meta-analysis

Zohra S. Lassi, Philippa F. Middleton, Zulfiqar A. Bhutta, Caroline Crowther

Research output: Contribution to journalReview article

24 Citations (Scopus)


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. Design: 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 middleincome 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 GRADEapproach, evidence was high quality except for the outcome ofmaternal 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.

Original languageEnglish
Article number31408
JournalGlobal Health Action
Issue number1
Publication statusPublished - 1 Jan 2016


  • Developing countries
  • Health care seeking
  • Low- and middle-income countries
  • Maternal health
  • Neonatal health
  • Neonatal mortality
  • Perinatal mortality

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this