Avoka, Cephas K, McArthur, Eve and Banke-Thomas, Aduragbemi 
ORCID: 0000-0002-4449-0131
(2022)
Interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub-Saharan Africa: A systematic review.
TROPICAL MEDICINE & INTERNATIONAL HEALTH, 27 (5).
pp. 494-508.
Abstract
<h4>Objective</h4>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).<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | emergency obstetric care, health systems, maternal health, referral, sub-Saharan Africa |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 27 Apr 2023 08:47 |
| Last Modified: | 27 Apr 2023 08:47 |
| DOI: | 10.1111/tmi.13747 |
| Open Access URL: | https://doi.org/10.1111/tmi.13747 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3170005 |
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