Reducing maternal and neonatal deaths in rural Malawi: evaluating the impact of a community-based women’s group intervention

.....................................................................................................................................3 List of figures.............................................................................................................................8 List of tables............................................................................................................................ 10 Additional material ............................................................................................................... 11 List of abbreviations ............................................................................................................. 12 Chapter 1 : Introduction ..................................................................................................... 14 1.1 Aim and chapter outline ......................................................................................................14 1.2 Overview ...................................................................................................................................15 Chapter 2 : Review of the epidemiology of maternal and neonatal mortality ........ 17 2.1 Methodological considerations in measuring maternal and neonatal mortality ..............................................................................................................................................................17 2.1.1 Case definition and classification systems ................................................................ 20 2.1.2 Incomplete identification and underreporting ........................................................... 22 2.1.3 Misclassification of cause of death ........................................................................... 24 2.1.4 Large margins of uncertainty .................................................................................... 26 2.1.5 Varying sources of data............................................................................................. 27 2.1.6 Use of ‘selected’ populations .................................................................................... 28 2.1.7 Summary of methodological considerations ............................................................. 28 2.2 Epidemiology of maternal and neonatal mortality....................................................29 2.2.1 Frequency.................................................................................................................. 29 2.2.2 Temporal trends......................................................................................................... 37 2.2.3 Distribution................................................................................................................ 40 2.2.4 Aetiology of maternal death ...................................................................................... 45 2.2.5 Aetiology of neonatal death ...................................................................................... 58 Chapter 3 : Review of evidence for community-based approaches to reduce maternal and neonatal mortality ....................................................................................... 66 3.1 Review of interventions to reduce maternal and neonatal mortality ................66 3.1.1 Antenatal interventions ............................................................................................. 70 3.1.2 Intrapartum interventions .......................................................................................... 74 3.1.3 Postnatal interventions .............................................................................................. 76 3.1.4 Summary of evidence and gaps in knowledge .......................................................... 78 3.2 Complex interventions for complex populations .......................................................81 3.2.1 Complex interventions .............................................................................................. 81 3.2.2 Complex populations................................................................................................. 86 3.3 Community-based interventions to reduce maternal and neonatal mortality89 3.3.1 The importance of community participation in health interventions ........................ 90