The evidence-base for facility-based deliveries in low- and middle income countries
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The Norwegian Agency for developement Cooperation asked the Norwegian Knowledge Center for the Health Services to provide a brief outline of the evidence-base for promoting facility-based deliveries in low- and middle income countries. Facility-based deliveries means that women give birth in health-centres and similar health facilities, typically with the attendance of skilled
health personnel (e.g. midwives), rather than at home (with or without a skilled
Systematic reviews (SRs) in The Cochrane Database of Systematic
Reviews, Database of Abstracts of Reviews of Effects, and the Health Technology
Assessment Database were searched. In addition PubMed for systematic reviews were searched.
No systematic review of studies comparing facility-based delivery
with home-based delivery in low and middle income countries was identified. But
two overview-articles where the effectiveness of promoting facility-based delivery
was a main topic was found.
The authors of the two overwiev-articles considered local health centres to be the best primary facility for deliveries with “midwives as the main providers, but other attendants working with them in a team”. They stated that “the treatment components would include all basic emergency obstetric functions, apart from blood transfusions or surgery, which would be available at the referral level as comprehensive emergency obstetric care.”
The authors concluded that “A health centre intra-partum strategy can be justified as the best bet to bring down high rates of maternal mortality,” but there is a lack of scientific evidence to support this.
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