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

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 and International Health, 27 (5). pp. 494-509. ISSN 1360-2276

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Identification Number: 10.1111/tmi.13747

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.

Item Type: Article
Official URL: https://onlinelibrary.wiley.com/journal/13653156
Additional Information: © 2022 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
Divisions: LSE Health
Subjects: R Medicine > RA Public aspects of medicine
Date Deposited: 26 Apr 2022 12:42
Last Modified: 16 May 2022 23:15
URI: http://eprints.lse.ac.uk/id/eprint/114959

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