Evidence-based interventions being done to reduce maternal mortality and morbidity across the world and in India: A Systematic Review

Abstract

Background: Maternal mortality remains a global concern, with 287,000 women dying in 2020 due to pregnancy-related causes. The majority of deaths occur in low- and middle-income countries, particularly in sub-Saharan Africa and South East Asia. While preventable, almost 800 women died daily from preventable causes related to pregnancy and childbirth in 2020.

Aim: This article aims to review evidence-based interventions at both the community and clinical levels that have effectively reduced maternal mortality and morbidity globally, focusing on India.

Methods: The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was conducted using PubMed, Embase, and Cochrane Central Register of Controlled Trials. Inclusion criteria encompassed randomized controlled trials (RCTs) published in English from 2003 to 2023, focusing on interventions specifying types and durations. Exclusion criteria included unclear interventions, success reports over 20 years old, and interventions with more than 2 arms.

Result: Among 26 selected clinical trials, diverse objectives, methods, and participant characteristics hindered formal meta-analysis. Most trials focused on hospital-based interventions, with pharmacological and non-pharmacological interventions showing efficacy. Risk of bias analysis revealed common uncertainties and challenges, particularly in blinding and participant/investigator accessors. Interventions to reduce maternal mortality and morbidity: Trials assessed pharmacological interventions such as Tranexamic acid, Misoprostol, Carbetocin, and others, alongside non-pharmacological interventions like uterine massage and nutritional management. While most interventions were effective, some studies reported non-significant differences. Risk of bias was present, emphasizing the need for rigorous methodologies.

Conclusion: The review underscores the success of interventions in reducing maternal mortality and morbidity globally, with most trials conducted in low- and middle-income countries. Findings highlight the effectiveness of various interventions, from drugs like Tranexamic acid to community-based initiatives. The results suggest the feasibility of reducing maternal mortality by identifying underlying factors and implementing evidence-based interventions, emphasizing the importance of both clinical and community-level approaches.