SynthesisPloS one2013
Do strategies to improve quality of maternal and child health care in lower and middle income countries lead to improved outcomes? A review of the evidence.
Synthesis in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
47 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Impact of Private Sector Delivery of Quality Care on Maternal, Newborn, and Child Health Outcomes in Low- and Middle-Income Countries: A Systematic Review.Annals of global health · 2025Pooled it
- Private sector quality of care for maternal, new-born, and child health in low-and-middle-income countries: a secondary review.Frontiers in global women's health · 2024Pooled it
- Assessing the quality of care for children attending health facilities: a systematic review of assessment tools.BMJ global health · 2021Pooled it
- Quality improvement initiatives for hospitalised small and sick newborns in low- and middle-income countries: a systematic review.Implementation science : IS · 2018Pooled it
- Health system and community level interventions for improving antenatal care coverage and health outcomes.The Cochrane database of systematic reviews · 2015Pooled it
- Maternal Cash Transfers Led To Increases In Facility Deliveries And Improved Quality Of Delivery Care In Nigeria.Health affairs (Project Hope) · 2020Trial
- Effect of a novel vital sign device on maternal mortality and morbidity in low-resource settings: a pragmatic, stepped-wedge, cluster-randomised controlled trial.The Lancet. Global health · 2019Trial
- Outcomes of a Coaching-Based WHO Safe Childbirth Checklist Program in India.The New England journal of medicine · 2017Trial
- Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan.Bulletin of the World Health Organization · 2017Trial
- Is essential newborn care provided by institutions and after home births? Analysis of prospective data from community trials in rural South Asia.BMC pregnancy and childbirth · 2014Trial
- Evaluation of the effectiveness of the World Health Organization Labor and Delivery Management Program on neonatal clinical outcomes of vaginal delivery.Journal of education and health promotion · 2026Article
- Use of Supervision Data to Improve Quality of Care for Malaria in Pregnancy: Experience in Six African Countries.The American journal of tropical medicine and hygiene · 2024Article
- Exploring variations in the implementation of a health system level policy intervention to improve maternal and child health outcomes in resource limited settings: A qualitative multiple case study from Uganda.PLOS global public health · 2024Article
- Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review.BMJ open · 2023Article
- "If you work alone on this project, you can't reach your target": unpacking the leader's role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19.BMC health services research · 2023Article
- Service delivery interventions to improve maternal and newborn health in low- and middle-income countries: scoping review of quality improvement, implementation research and health system strengthening approaches.BMC health services research · 2023Article
- From purists to pragmatists: a qualitative evaluation of how implementation processes and contexts shaped the uptake and methodological adaptations of a maternal and neonatal quality improvement programme in South Africa prior to, and during COVID-19.BMC health services research · 2023Article
- Identification of Clinician Training Techniques as an Implementation Strategy to Improve Maternal Health: A Scoping Review.International journal of environmental research and public health · 2023Article
- Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation.Journal of medical Internet research · 2023Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesEfforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship.
methodsWe undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence.
findingsMethodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions.
conclusionExisting evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on non-facility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.