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Evaluating effectiveness of complex interventions aimed at reducing maternal mortality in developing countries.

Louise Ross1, Padam Simkhada, W Cairns S Smith

  • 1Department of Child Health, University of Aberdeen, Westburn Road, Scotland. l.ross@abdn.ac.uk

Journal of Public Health (Oxford, England)
|October 20, 2005
PubMed
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Cluster randomized trials and quasi-experimental designs may be more suitable than traditional randomized controlled trials for evaluating interventions to reduce maternal mortality in developing countries. Further research is needed to enhance these alternative study designs.

Area of Science:

  • Global Health
  • Epidemiology
  • Maternal Health

Background:

  • Millennium Development Goal to reduce global mortality.
  • Randomized controlled trials (RCTs) are gold standard but not always feasible in developing countries.
  • Evaluating complex interventions for maternal mortality reduction requires appropriate study designs.

Purpose of the Study:

  • To examine the utility of cluster randomized trials and quasi-experimental designs.
  • To assess their suitability for evaluating interventions aimed at reducing maternal mortality in developing countries.

Main Methods:

  • Systematic literature search of multiple electronic databases (1990-2003).
  • Inclusion of English language publications on complex interventions for maternal mortality.

Related Experiment Videos

  • Analysis of four cluster randomized trials and eleven quasi-experimental studies.

    • Main Results:

    • Two cluster RCTs showed no adverse effects of reduced prenatal visits on maternal mortality.
    • Two cluster RCTs indicated significant maternal mortality reduction with vitamin A supplementation.
    • Eight non-randomized studies reported a decline in maternal deaths, despite methodological challenges.

    Conclusions:

    • Cluster RCTs and quasi-experimental designs may be more appropriate than RCTs for evaluating complex maternal mortality interventions.
    • Methodological limitations in existing studies necessitate further work to improve the robustness of these alternative designs.
    • Improving measurement of maternal mortality and addressing confounding factors are crucial for future research.