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Research article
Quality and women’s satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: A systematic review
Edward Kwabena Ameyaw
University of Technology Sydney
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6617-237X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Pregnancy and Childbirth.
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
Keywords
Quality maternal referral, maternal referral practices, sub-Saharan Africa, signal functions, referral standards, women’s satisfaction, referral guidelines
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CURRENT STATUS: Published
Version 4
Posted 29 Sep, 2020
No comments provided
Editorial decision: Major revision
On 15 Sep, 2020
Review #1 received
Received 10 Sep, 2020
Reviewer #1 agreed
On 20 Aug, 2020
Reviewers invited
Invitations sent on 17 Aug, 2020
Editor assigned
On 20 Jul, 2020
Submission checks complete
On 19 Jul, 2020
Editor invited
On 19 Jul, 2020
No comments provided
Editorial decision: Major revision
On 17 Jul, 2020
Review #1 received
Received 19 Apr, 2020
Reviewer #1 agreed
On 01 Apr, 2020
Editor assigned
On 27 Mar, 2020
Reviewers invited
Invitations sent on 27 Mar, 2020
Submission checks complete
On 26 Mar, 2020
Editor invited
On 26 Mar, 2020
No comments provided
Editorial decision: Major revision
On 12 Mar, 2020
Review #2 received
Received 05 Mar, 2020
Reviewer #2 agreed
On 24 Feb, 2020
Review #1 received
Received 29 Nov, 2019
Reviewer #1 agreed
On 11 Oct, 2019
Reviewers invited
Invitations sent on 08 Oct, 2019
Editor assigned
On 09 Sep, 2019
Submission checks complete
On 10 Aug, 2019
Editor invited
On 10 Aug, 2019
First submitted
On 08 Aug, 2019
Metrics
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PDF Downloads: ...
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Subject Areas
Maternal & Fetal Medicine
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This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Quality and women’s satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: A systematic review
Edward Kwabena Ameyaw
University of Technology Sydney
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6617-237X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 29 Sep, 2020
No comments provided
Editorial decision: Major revision
On 15 Sep, 2020
Review #1 received
Received 10 Sep, 2020
Reviewer #1 agreed
On 20 Aug, 2020
Reviewers invited
Invitations sent on 17 Aug, 2020
Editor assigned
On 20 Jul, 2020
Submission checks complete
On 19 Jul, 2020
Editor invited
On 19 Jul, 2020
No comments provided
Editorial decision: Major revision
On 17 Jul, 2020
Review #1 received
Received 19 Apr, 2020
Reviewer #1 agreed
On 01 Apr, 2020
Editor assigned
On 27 Mar, 2020
Reviewers invited
Invitations sent on 27 Mar, 2020
Submission checks complete
On 26 Mar, 2020
Editor invited
On 26 Mar, 2020
No comments provided
Editorial decision: Major revision
On 12 Mar, 2020
Review #2 received
Received 05 Mar, 2020
Reviewer #2 agreed
On 24 Feb, 2020
Review #1 received
Received 29 Nov, 2019
Reviewer #1 agreed
On 11 Oct, 2019
Reviewers invited
Invitations sent on 08 Oct, 2019
Editor assigned
On 09 Sep, 2019
Submission checks complete
On 10 Aug, 2019
Editor invited
On 10 Aug, 2019
First submitted
On 08 Aug, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Maternal & Fetal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Pregnancy and Childbirth.
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