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Systematic Reviews

, 2:55

First Online: 06 July 2013Received: 11 April 2013Accepted: 25 June 2013DOI: 10.1186-2046-4053-2-55

Cite this article as: Langlois, É.V., Miszkurka, M., Ziegler, D. et al. Syst Rev 2013 2: 55. doi:10.1186-2046-4053-2-55


BackgroundEach year, 287,000 women die from complications related to pregnancy or childbirth, and 3.8 million newborns die before reaching 28 days of life. The near totality 99% of maternal and neonatal deaths occurs in low- and middle-income countries LMICs. Utilization of essential obstetric care services including postnatal care PNC largely contributes to the reduction of maternal and neonatal mortality and morbidity. There is a strong need to evaluate the evidence on the unmet needs in utilization of PNC services to inform health policy planning. Our objective is to assess systematically the socioeconomic, geographic and demographic inequalities in the use of PNC interventions in low- and middle-income countries.

Methods-DesignThe current protocol adopts a strategy informed by the guidelines of The Cochrane Handbook for Systematic Reviews. Our systematic review will identify studies in English, French, Spanish, Portuguese and Chinese – provided inclusion of an English abstract - from 1960 onwards, by searching MEDLINE PubMed interface, EMBASE OVID interface, Cochrane Central OVID interface and the gray literature. Study selection criteria include research setting, study design, reported outcomes and determinants of interest. Our primary outcome is the utilization of PNC services, and determinants of concern are: 1 socioeconomic status for example, income, education; 2 geographic determinants for example, distance to a health center, rural versus urban residence; and 3 demographic determinants for example, ethnicity, immigration status. Screening, data abstraction, and scientific quality assessment will be conducted independently by two reviewers using standardized forms. Where feasible, study results will be combined through meta-analyses to obtain a pooled measure of association between utilization of PNC services and key determinants. Results will be stratified by countries’ income levels World Bank classification.

DiscussionOur review will inform policy-making with the aim of decreasing inequalities in utilization of PNC services. This research will provide evidence on unmet needs for PNC services in LMICs, knowledge gaps and recommendations to health policy planners. Our research will help promote universal coverage of quality PNC services as an integral part of the continuum of maternal and child health care. This protocol was registered with the Prospero database registration number: CRD42013004661.

KeywordsPostnatal care Health services utilization Maternal health Low- and middle-income countries Inequalities Systematic review Protocol AbbreviationsANCAntenatal care

CBAsControlled before-after studies

CDCCenters for disease control and prevention

DHSDemographic and health surveys

EBFExclusive breastfeeding

EPHPPEffective public health practice project

ICCIntraclass correlation coefficient

ITSInterrupted time series

LBWLow birth weight

LMICsLow- and middle-income countries

MeSHMedical subject headings

PNCPostnatal care

PRISMAPreferred reporting items for systematic reviews and meta-analyses

RCTRandomized controlled trial

SBASkilled birth attendant

WHOWorld Health Organization.

Electronic supplementary materialThe online version of this article doi:10.1186-2046-4053-2-55 contains supplementary material, which is available to authorized users.

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Autor: Étienne V Langlois - Malgorzata Miszkurka - Daniela Ziegler - Igor Karp - Maria Victoria Zunzunegui


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