What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review
1 Division of Global Health (IHCAR), Department of Public Health, Karolinska Institutet, Nobels väg 9, SE-171 77, Solna Stockholm, Sweden
2 Peking University China Center for Health Development Studies, Mailbox 505, Xue Yuan Road 38, Beijing 100191, China
3 International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, University Hospital, Akademiska sjukhuset, Uppsala SE-751 85, Sweden
4 School of Public Health, Fudan University, Shanghai 200032, China
5 Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, 90187 Umeå, Sweden
BMC Public Health 2014, 14:634 doi:10.1186/1471-2458-14-634Published: 21 June 2014
The deadline for achieving Millennium Development Goals 4 and 5 is approaching, but inequalities between disadvantaged and other populations is a significant barrier for progress towards achieving these goals. This systematic review aims to collect evidence about the differential effects of interventions on different sociodemographic groups in order to identify interventions that were effective in reducing maternal or child health inequalities.
We searched the PubMed, EMBASE and other relevant databases. The reference lists of included reviews were also screened to find more eligible studies. We included experimental or observational studies that assessed the effects of interventions on maternal and child health, but only studies that report quantitative inequality outcomes were finally included for analysis.
22 articles about the effectiveness of interventions on equity in maternal and child health were finally included. These studies covered five kinds of interventions: immunization campaigns, nutrition supplement programs, health care provision improvement interventions, demand side interventions, and mixed interventions. The outcome indicators covered all MDG 4 and three MDG 5 outcomes. None of the included studies looked at equity in maternal mortality, adolescent birth rate and unmet need for family planning. The included studies reported inequalities based on gender, income, education level or comprehensive socioeconomic status. Stronger or moderate evidence showed that all kinds of the included interventions may be more effective in improving maternal or child health for those from disadvantaged groups.
Studies about the effectiveness of interventions on equity in maternal or child health are limited. The limited evidence showed that the interventions that were effective in reducing inequity included the improvement of health care delivery by outreach methods, using human resources in local areas or provided at the community level nearest to residents and the provision of financial or knowledge support to demand side.