Integrated maternal, newborn and child-health strategies and interventions for reducing maternal and child mortality in Nigeria: a systematic review

Abstract

Maternal and child mortality remain major public health challenges in Nigeria, contributing disproportionately to the global burden. Despite numerous interventions, progress towards Sustainable Development Goals (SDGs) 3.1 and 3.2 has been slow. This study synthesises evidence on integrated strategies, initiatives, and interventions implemented in Nigeria to reduce maternal and child mortality and improve related health outcomes. This systematic review, conducted in accordance with PRISMA 2020, synthesised evidence from primary studies evaluating integrated maternal, newborn and child health (MNCH) interventions in Nigeria. The review incorporated two search phases: an initial search conducted in 2015 and an updated search performed in 2024 covering eligible studies published between 2010 and 2024. Ten electronic databases were searched. Eligible studies (n = 14) included experimental, quasi-experimental, observational, and mixed-method designs. Data were extracted on study characteristics, intervention type, outcomes, and effectiveness, and quality appraisal was performed using a harmonized tool adapted from the Critical Appraisal Skills Programme (CASP) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) tools. Fourteen studies met the inclusion criteria, spanning diverse geopolitical zones. Eleven measures were employed to assess the impact of integrated approaches on maternal and child health. Of the five maternal health measures, three showed consistent improvements (antenatal care visits, use of skilled birth attendants, and home visits by health workers), while two had mixed results (family planning and maternal mortality). Of the six child health measures, three demonstrated positive outcomes (tetanus protection, exclusive breastfeeding, and reductions in neonatal, infant, and child mortality), while three showed mixed outcomes (postnatal care, immunisation, and antibiotic treatment for pneumonia). Reported barriers to implementation included workforce shortages (particularly female staff), weak supply chains, poor health worker attitudes, supervision gaps, and infrastructural deficits. Facilitators included skilled and culturally acceptable staff, uninterrupted commodity supply, functional referral and transport systems, participatory community engagement, and enabling policies. Integrated approaches can reduce maternal and child mortality and improve outcomes, particularly when supply-side measures - such as skilled staff, functional facilities, and reliable commodities - are combined with demand-side strategies, including financial protection and community mobilization. Effectiveness is maximised when interventions are tailored to sociocultural norms, access barriers, and health system capacity. Sustained progress requires scaling up context-specific, community-engaged strategies in northern and rural regions while addressing persistent health system barriers. Further region-specific research with robust designs is needed to assess long-term impact and cost-effectiveness. Retrospectively registered on Prospero with ID CRD420251126776 on 21st August 2025.