Interventions to improve skilled birth attendance in sub-Saharan Africa. What has been done, and what has worked? A narrative synthesis

Abstract

Background: With only 64 % of births attended by skilled professionals and a maternal mortality ratio of 536 per 100,000 live births, Sub-Saharan Africa needs targeted interventions to improve skilled birth attendants' utilisation and reduce maternal mortality.

Aim: To identify the interventions implemented across Sub-Saharan Africa to improve skilled birth attendants' uptake and identify the contextual factors influencing the interventions' implementation, effectiveness, and sustainability.

Methods: The review followed the fundamentals of narrative synthesis. A search was conducted in March 2023 and updated in September 2024 on five electronic databases to identify relevant primary qualitative, quantitative and mixed-method studies that have reported any intervention in Sub-Saharan Africa to improve skilled birth attendants patronage.

Finding: Of the 4376 electronically retrieved articles, 34 peer-reviewed studies from 12 countries met the final selection criteria and have been included in this review. Interventions identified were grouped into Free/Subsidised Maternal Health Care, Mobile Health, Maternity Waiting Homes, Community-Based Interventions, Prenatal Education and Integrated Packages. Most of the interventions effectively promoted the utilisation of skilled birth attendants. Key factors influencing intervention success included men's involvement, community leadership, maternal literacy, socioeconomic status, distance to facilities, local government support, and technological resources, with lower socioeconomic communities benefiting most.

Conclusion: The findings from this review support the theory that interventions work differently in different contexts; hence, it is vital to understand the population's needs, identify the available resources and deliver custom-made interventions.

Keywords: Maternal Health; Narrative synthesis; Skilled birth attendant; Sub-Saharan Africa; Women.