Quality and women’s satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: A systematic review
Background: sub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highest burden of maternal and perinatal morbidity and mortality in the world. Timely and appropriate maternal referral to a suitable health facility is an indicator of effective health systems. In this systematic review we aimed to identify which referral practices are delivered according to accepted standards for pregnant women and newborns in sSA LLMICs by competent healthcare providers in line with the needs of pregnant women.
Methods: Six electronic databases were systematically searched for primary data studies (2009-2018) in English reporting on maternal referral practices and their effectiveness. We conducted a content analysis guided by a framework for assessing the quality of maternal referral. Quality referral was defined as: timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers in the receiving facility.
Results: Seventeen articles were included in the study. Most studies were quantitative (n=11). Two studies reported that women were dissatisfied due to delays in referral processes that affected their health. Most articles (10) reported that women were not accompanied to higher levels of care, delays in referral processes, transport challenges and poor referral documentation. Some healthcare providers administered essential drugs such as misoprostol prior to referral.
Conclusions: Efforts to improve maternal health in LLMICs should aim to enhance maternity care providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate barriers of referral. To ensure quality maternal referral, district level health managers should be trained and equipped with the skills needed to monitor and evaluate referral documentation, including quality and efficiency of maternal referrals.
Systematic review registration: PROSPERO registration CRD42018114261
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On 10 Aug, 2019
On 08 Aug, 2019
Quality and women’s satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: A systematic review
Posted 29 Sep, 2020
On 15 Sep, 2020
Received 10 Sep, 2020
On 20 Aug, 2020
Invitations sent on 17 Aug, 2020
On 20 Jul, 2020
On 19 Jul, 2020
On 19 Jul, 2020
On 17 Jul, 2020
Received 19 Apr, 2020
On 01 Apr, 2020
On 27 Mar, 2020
Invitations sent on 27 Mar, 2020
On 26 Mar, 2020
On 26 Mar, 2020
On 12 Mar, 2020
Received 05 Mar, 2020
On 24 Feb, 2020
Received 29 Nov, 2019
On 11 Oct, 2019
Invitations sent on 08 Oct, 2019
On 09 Sep, 2019
On 10 Aug, 2019
On 10 Aug, 2019
On 08 Aug, 2019
Background: sub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highest burden of maternal and perinatal morbidity and mortality in the world. Timely and appropriate maternal referral to a suitable health facility is an indicator of effective health systems. In this systematic review we aimed to identify which referral practices are delivered according to accepted standards for pregnant women and newborns in sSA LLMICs by competent healthcare providers in line with the needs of pregnant women.
Methods: Six electronic databases were systematically searched for primary data studies (2009-2018) in English reporting on maternal referral practices and their effectiveness. We conducted a content analysis guided by a framework for assessing the quality of maternal referral. Quality referral was defined as: timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers in the receiving facility.
Results: Seventeen articles were included in the study. Most studies were quantitative (n=11). Two studies reported that women were dissatisfied due to delays in referral processes that affected their health. Most articles (10) reported that women were not accompanied to higher levels of care, delays in referral processes, transport challenges and poor referral documentation. Some healthcare providers administered essential drugs such as misoprostol prior to referral.
Conclusions: Efforts to improve maternal health in LLMICs should aim to enhance maternity care providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate barriers of referral. To ensure quality maternal referral, district level health managers should be trained and equipped with the skills needed to monitor and evaluate referral documentation, including quality and efficiency of maternal referrals.
Systematic review registration: PROSPERO registration CRD42018114261
Figure 1