Lancet
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Clinical Trial Controlled Clinical Trial
Effect on mortality of community-based maternity-care programme in rural Bangladesh.
Various community-based interventions have been proposed to improve maternity care, but hardly any studies have reported the effect of these measures on maternal mortality. In this study, the efficacy of a maternity-care programme to reduce maternal mortality has been evaluated in the context of a primary health-care project in rural Bangladesh. Trained midwives were posted in villages, and asked to attend as many home-deliveries as possible, detect and manage obstetric complications at onset, and accompany patients requiring referral for higher-level care to the project central maternity clinic. ⋯ By contrast, during the following 3 years, the ratio was significantly lower in the programme than in the control area (1.4 vs 3.8 per 1000 live births, p = 0.02). The findings suggest that maternal survival can be improved by the posting of midwives at village level, if they are given proper training, means, supervision, and back-up. The inputs for such a programme to succeed and the constraints of its replication on a large scale should not be underestimated.
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The enthusiasm for meta-analyses (or overviews) expressed by their proponents is not always shared by the broader medical community. To encourage constructive debate, we adopt a critical perspective on the conduct and interpretation of meta-analysis. ⋯ We conclude that meta-analysis is not an exact statistical science that provides definitive simple answers to complex clinical problems. It is more appropriately viewed as a valuable objective descriptive technique, which often furnishes clear qualitative conclusions about broad treatment policies, but whose quantitative results have to be interpreted cautiously.