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Perinatal interventions and survival in resource-poor settings: which work, which don't, which have the jury out?
  1. David Osrin,
  2. Audrey Prost
  1. Centre for International Health and Development, UCL Institute of Child Health, London, UK
  1. Correspondence to David Osrin, Centre for International Health and Development, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; d.osrin{at}ich.ucl.ac.uk

Abstract

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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Footnotes

  • Funding DO is supported by The Wellcome Trust (081052/Z/06/Z).

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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