What works? Strategies to increase reproductive, maternal and child health in difficult to access mountainous locations: a systematic literature review

Byrne, Abbey, Hodge, Andrew, Jimenez-Soto, Eliana and Morgan, Alison (2014) What works? Strategies to increase reproductive, maternal and child health in difficult to access mountainous locations: a systematic literature review. PLoS One, 9 2: e87683.1-e87683.7. doi:10.1371/journal.pone.0087683


Author Byrne, Abbey
Hodge, Andrew
Jimenez-Soto, Eliana
Morgan, Alison
Title What works? Strategies to increase reproductive, maternal and child health in difficult to access mountainous locations: a systematic literature review
Journal name PLoS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2014-02-03
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1371/journal.pone.0087683
Open Access Status DOI
Volume 9
Issue 2
Start page e87683.1
End page e87683.7
Total pages 7
Place of publication San Francisco, CA, United States
Publisher Public Library of Science
Collection year 2015
Language eng
Formatted abstract
Background: Geography poses serious challenges to delivery of health services and is a well documented marker of inequity. Maternal, newborn and child health (MNCH) outcomes are poorer in mountainous regions of low and lower-middle income countries due to geographical inaccessibility combined with other barriers: poorer quality services, persistent cultural and traditional practices and lower socioeconomic and educational status. Reaching universal coverage goals will require attention for remote mountain settings. This study aims to identify strategies to address barriers to reproductive MNCH (RMNCH) service utilisation in difficult-to-reach mountainous regions in low and lower-middle income settings worldwide.

Methods: A systematic literature review drawing from MEDLINE, Web of Science, Scopus, Google Scholar, and Eldis. Inclusion was based on; testing an intervention for utilisation of RMNCH services; remote mountain settings of low- and lower-middle income countries; selected study designs. Studies were assessed for quality and analysed to present a narrative review of the key themes.

Findings: From 4,130 articles 34 studies were included, from Afghanistan, Bolivia, Ethiopia, Guatemala, Indonesia, Kenya, Kyrgyzstan, Nepal, Pakistan, Papua New Guinea and Tajikistan. Strategies fall into four broad categories: improving service delivery through selected, trained and supported community health workers (CHWs) to act alongside formal health workers and the distribution of critical medicines to the home; improving the desirability of existing services by addressing the quality of care, innovative training and supervision of health workers; generating demand by engaging communities; and improving health knowledge for timely care-seeking. Task shifting, strengthened roles of CHWs and volunteers, mobile teams, and inclusive structured planning forums have proved effective.

Conclusions: The review highlights where known evidence-based strategies have increased the utilisation of RMNCH services in low income mountainous areas. While these are known strategies in public health, in such disadvantaged settings additional supports are required to address both supply and demand barriers.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2015 Collection
School of Public Health Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 4 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 6 times in Scopus Article | Citations
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Created: Thu, 06 Feb 2014, 10:14:56 EST by Dr Andrew Hodge on behalf of School of Public Health