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      Male involvement and maternal health outcomes: systematic review and meta-analysis

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          Abstract

          Background

          The developing world accounts for 99% of global maternal deaths. Men in developing countries are the chief decision-makers, determining women's access to maternal health services and influencing their health outcomes. At present, it is unclear whether involving men in maternal health can improve maternal outcomes. This systematic review and meta-analysis aimed to investigate the impact of male involvement on maternal health outcomes of women in developing countries.

          Methods

          Four electronic databases and grey literature sources were searched (up to May 2013), together with reference lists of included studies. Two reviewers independently screened and assessed the quality of studies based on prespecified criteria. Measures of effects were pooled and random effect meta-analysis was conducted, where possible.

          Results

          Fourteen studies met the inclusion criteria. Male involvement was significantly associated with reduced odds of postpartum depression (OR=0.36, 95% CI 0.19 to 0.68 for male involvement during pregnancy; OR=0.34, 95% CI 0.19 to 0.62 for male involvement post partum), and also with improved utilisation of maternal health services (skilled birth attendance and postnatal care). Male involvement during pregnancy and at post partum appeared to have greater benefits than male involvement during delivery.

          Conclusions

          Male involvement is associated with improved maternal health outcomes in developing countries. Contrary to reports from developed countries, there was little evidence of positive impacts of husbands’ presence in delivery rooms. However, more rigorous studies are needed to improve this area's evidence base.

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          Most cited references 43

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          Measuring inconsistency in meta-analyses.

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            Meta-analysis in clinical trials.

            This paper examines eight published reviews each reporting results from several related trials. Each review pools the results from the relevant trials in order to evaluate the efficacy of a certain treatment for a specified medical condition. These reviews lack consistent assessment of homogeneity of treatment effect before pooling. We discuss a random effects approach to combining evidence from a series of experiments comparing two treatments. This approach incorporates the heterogeneity of effects in the analysis of the overall treatment efficacy. The model can be extended to include relevant covariates which would reduce the heterogeneity and allow for more specific therapeutic recommendations. We suggest a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.
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              Fathers' involvement and children's developmental outcomes: a systematic review of longitudinal studies.

              This systematic review aims to describe longitudinal evidence on the effects of father involvement on children's developmental outcomes. Father involvement was conceptualized as accessibility (cohabitation), engagement, responsibility or other complex measures of involvement. Both biological fathers and father figures were included. We searched all major databases from the first dates. Data on father involvement had to be generated at least 1 year before measuring offspring outcomes. N = 24 publications were included in the overview: 22 of these described positive effects of father involvement, whereof 16 studies had controlled for SES and 11 concerned the study population as a whole [five socio-economic status (SES)-controlled]. There is certain evidence that cohabitation with the mother and her male partner is associated with less externalising behavioural problems. Active and regular engagement with the child predicts a range of positive outcomes, although no specific form of engagement has been shown to yield better outcomes than another. Father engagement seems to have differential effects on desirable outcomes by reducing the frequency of behavioural problems in boys and psychological problems in young women, and enhancing cognitive development, while decreasing delinquency and economic disadvantage in low SES families. There is evidence to support the positive influence of father engagement on offspring social, behavioural and psychological outcomes. Although the literature only provides sufficient basis for engagement (direct interaction with the child) as the specific form of 'effective' father involvement, there is enough support to urge both professionals and policy makers to improve circumstances for involved fathering.
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                Author and article information

                Journal
                J Epidemiol Community Health
                J Epidemiol Community Health
                jech
                jech
                Journal of Epidemiology and Community Health
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0143-005X
                1470-2738
                June 2015
                19 February 2015
                : 69
                : 6
                : 604-612
                Affiliations
                Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital , Nottingham, UK
                Author notes
                [Correspondence to ] Dr Jo Leonardi-Bee, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham NG5 1PB, UK; jo.leonardi-bee@ 123456nottingham.ac.uk
                Article
                jech-2014-204784
                10.1136/jech-2014-204784
                4453485
                25700533
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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