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. 2022 May;27(5):494-509.
doi: 10.1111/tmi.13747. Epub 2022 Apr 5.

Interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub-Saharan Africa: A systematic review

Cephas K Avoka  1   2 , Eve McArthur  3 , Aduragbemi Banke-Thomas  4   5
Affiliations

Interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub-Saharan Africa: A systematic review

Cephas K Avoka et al. Trop Med Int Health. 2022 May.

Abstract

Objective: The objective of the study was to review the evidence on interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub-Saharan Africa (SSA).

Methods: A systematic search of PubMed, Embase, Cochrane Register and CINAHL Plus was conducted to identify studies on obstetric emergency referral in SSA. Studies were included based on pre-defined eligibility criteria. Details of reported referral interventions were extracted and categorised. The Joanna Biggs Institute Critical Appraisal checklists were used for quality assessment of included studies. A formal narrative synthesis approach was used to summarise findings guided by the WHO's referral system flow.

Results: A total of 14 studies were included, with seven deemed high quality. Overall, 7 studies reported referral decision-making interventions including training programmes for health facility and community health workers, use of a triage checklist and focused obstetric ultrasound, which resulted in improved knowledge and practice of recognising danger signs for referral. 9 studies reported on referral communication using mobile phones and referral letters/notes, resulting in increased communication between facilities despite telecommunication network failures. Referral decision making and communication interventions achieved a perceived reduction in maternal mortality. 2 studies focused on referral feedback, which improved collaboration between health facilities.

Conclusion: There is limited evidence on how well referral interventions work in sub-Saharan Africa, and limited consensus regarding the framework underpinning the expected change. This review has led to the proposition of a logic model that can serve as the base for future evaluations which robustly expose the (in)efficiency of referral interventions.

Keywords: emergency obstetric care; health systems; maternal health; referral; sub-Saharan Africa.

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Figures

FIGURE 1
FIGURE 1
Referral identification/decision making, communication and feedback loop
FIGURE 2
FIGURE 2
Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) Chart
FIGURE 3
FIGURE 3
Map of Africa with included studies
FIGURE 4
FIGURE 4
Logic model for referral interventions
See this image and copyright information in PMC

References

    1. World Health Organization W . Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary. Geneva: World Health Organization; 2000. p. 2019.
    1. UNICEF . A neglected tragedy: the global burden of stillbirths [Internet]. UNICEF DATA. 2020. [cited 2021 Jul 6]. Available from: https://data.unicef.org/resources/a‐neglected‐tragedy‐stillbirth‐estimat...
    1. World Health Organization . Monitoring emergency obstetric care. 2009. [cited 2022 Mar 26]. Available from: https://www.who.int/publications/i/item/9789241547734
    1. Bhandari TR, Dangal G. Emergency obstetric care: strategy for reducing maternal mortality in developing countries. 2014. [cited 2021 Sep 2]. Available from: https://clacaidigital.info/handle/123456789/627
    1. WHO | Management of health facilities: Referral systems. WHO. Available from: https://www.who.int/management/facility/referral/en/ [Accessed March 26, 2022].

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