Journal
ARCHIVES OF DISEASE IN CHILDHOOD
Volume 95, Issue 12, Pages 1039-1046Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/adc.2009.179366
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Funding
- Wellcome Trust [081052/Z/06/Z]
- UK Department for International Development
- Wellcome Trust Strategic Group on the Population Science of Maternal and Child Survival
- Wellcome Trust [081052/Z/06/Z] Funding Source: Wellcome Trust
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Perinatal conditions make the largest contribution to the burden of disease in low-income countries. Although postneonatal mortality rates have declined, stillbirth and early neonatal mortality rates remain high in many countries in Africa and Asia, and there is a concentration of mortality around the time of birth. Our article begins by considering differences in the interpretation of 'intervention' to improve perinatal survival. We identify three types of intervention: a single action, a collection of actions delivered in a package and a broader social or system approach. We use this classification to summarise the findings of recent systematic reviews and meta-analyses. After describing the growing evidence base for the effectiveness of community-based perinatal care, we discuss current concerns about integration: of women's and children's health programmes, of community-based and institutional care, and of formal and informal sector human resources. We end with some thoughts on the complexity of choices confronting women and their families in low-income countries, particularly in view of the growth in non-government and private sector healthcare.
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