Health Systems Interventions for Prevention of Maternal Peripartum Infection in Low and Middle Income Countries: A Systematic Review

Abstract

Abstract Background Maternal peripartum infection is still a widespread avoidable problem in Low and Middle Income countries (LMICs) despite developments in postnatal care. Lately systems approach, encompassing all the factors in the health system, is being recognized as ameliorate option for the improvement of maternal health and prevention of maternal mortality. Objective:The aim of this systematic review was to identify and evaluate interventions to prevent maternal peripartum infection in LMICs. Methods -The Cochrane Library, CINAHL, MEDLINE (via PubMed) and Scopus,World Health Organization (WHO) ,the National Institute for Health and Care Excellence (NICE) websites were searched to identify interventional studies to prevent maternal peripartum infection using the PRISMA model. The article searching was conducted for a period of 3 months (01/08/2022 to 30/10/2022). Search terms were “Peripartum”, “Infection”, “Genital tract”, and their MESH terms. The inclusion criteria were primary studies that reported interventions for the prevention of maternal peripartum infection, studies from LMICs and those written in English language. Cochrane Risk of Bias tools were used to appraise the quality of the studies. Results – From 1662 article results,29 articles were included covering 56,151 participants. The interventions were grouped into six domains: antibiotic prophylaxis 11(37.9% of studies), self-care training 6 (20.6%), skin preparation 6 (20.6%), systems approach 2 (6.9%), Traditional Birth Attendant training (6.9 %) and use of Clean Delivery Kit 2(6.9%).12 studies reported a significantly lower risk of infection. Six studies reported a significantly improved knowledge and practice of women regarding maternal peripartum infection. Two studies reported no change in the risk of infection. Conclusion- There is limited research from LMICs on interventions to prevent maternal peripartum infection, however the studies are of good quality. The study identified six domains of interventions which were mainly inpatient settings targeting maternal peripartum infection in isolation without consideration of other system components. This provides an opportunity for achieving optimum reduction in maternal peripartum infection though systems approach. Health systems interventional studies are therefore needed to further the gains in maternal peripartum infections prevention in LMICs. Study registration: PROSPERO CRD42022342550