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Open Access Highly Accessed Research article

Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh

Anisur Rahman1*, Allisyn Moran1, Jesmin Pervin1, Aminur Rahman1, Monjur Rahman1, Sharifa Yeasmin1, Hosneara Begum1, Harunor Rashid1, Mohammad Yunus1, Daniel Hruschka2, Shams E Arifeen1, Peter K Streatfield1, Lynn Sibley3, Abbas Bhuiya1 and Marge Koblinsky4

Author Affiliations

1 Centre for Reproductive Health, icddr,b, Mohakhali, Dhaka 1212, Bangladesh

2 School of Human Evolution and Social Change, Arizona State University, P.O. Box 872402, Tempe, AZ 85287-2402, USA

3 Emory University, 1520 Clifton Road, NE, Atlanta, GA 30322-4027, USA

4 John Snow Inc, 1776 Massachusetts Avenue, Suite 300, Washington, DC, USA

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BMC Public Health 2011, 11:914  doi:10.1186/1471-2458-11-914

Published: 10 December 2011

Abstract

Background

Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality.

Methods

This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas.

Results

Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018).

Conclusion

The continuum of care approach provided through the integration of service delivery modes decreased the perinatal mortality rate within a short period of time. Further testing of this model is warranted within the government health system in Bangladesh and other low-income countries.