Community-based care to improve maternal, newborn, and child health

Individual Author(s) / Organizational Author
Lassi, Zohra S
Kumar, Rohail
Bhutta, Zulfiqar A
The World Bank
April 2016
Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition
Abstract / Description

Significant progress has been made in maternal, newborn, and child health (MNCH) in recent decades. Between 1990 and 2015, the global mortality rate for children under age five years dropped by 53 percent, from 90.6 deaths per 1,000 live births in 1990 to 42.5 in 2015 (). Maternal mortality is also on the decline globally.

Despite progress, maternal, neonatal, and under-five mortality remain high in many low- and middle-income countries (LMICs). In 2015, approximately 303,000 women died as a result of complications from pregnancy and childbirth (). Globally, an estimated 5.9 million children under age five years die each year, including 2.7 million within the first month of life ().

Health indicators differ across countries, regions, and socioeconomic levels (). Approximately 99 percent of all newborn deaths occur in LMICs (). Maternal mortality is concentrated in Sub-Saharan Africa (), where mortality rates for the poor are double those for the nonpoor, and they are higher among rural populations and women with low levels of education (PLoS Medicine Editors ). Children living in low-income countries are three times more likely to die before age five years than children living in high-income countries (HICs) ().

Pneumonia, diarrhea, malaria, and inadequate nutrition drive early childhood deaths around the world. In 2015, an estimated 526,000 episodes of diarrhea and 922,000 cases of pneumonia in children under age five years led to death (). Undernutrition is a primary underlying cause of 3.5 million maternal and child deaths each year (); stunting, wasting, and micronutrient deficiencies are responsible for approximately 35 percent of the disease burden in children under age five years and 11 percent of the total global disease burden (). Although maternal mortality is caused chiefly by postpartum hemorrhage, preeclampsia and eclampsia, and sepsis, a large proportion of maternal deaths can be attributed to limited access to skilled care during childbirth and the postnatal period () as well as to limited access to family planning services and safe abortions ().

An appropriate mix of interventions can significantly reduce the burden of maternal and child mortality and morbidity. However, these interventions often do not reach those who need them most (). An integrated approach that includes community-based care as an essential component has the potential to substantially improve maternal, newborn, and child health outcomes.

This chapter provides a summary of community-based programs for improving MNCH. The chapter discusses strategies to improve the supply of services, including through community-based interventions and home visitations implemented by community health workers (CHWs), and strategies to increase demand for services, including through community mobilization efforts. The chapter summarizes the evidence about the impact of such interventions, describes contextual factors that affect implementation, and considers issues of cost-effectiveness. It concludes by highlighting research gaps, the challenges of scaling up, and the way forward.

(author introduction)

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