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. 494-509. ISSN 1360-2276 (Print), 1365-3156 (Online) (doi:https://doi.org/10.1111/tmi.13747)

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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
Uncontrolled Keywords:	emergency obstetric care, health systems, maternal health, referral, sub-Saharan Africa
Subjects:	H Social Sciences > HD Industries. Land use. Labor > HD61 Risk Management R Medicine > RG Gynecology and obstetrics
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Vulnerable Children and Families Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	09 May 2022 14:50
URI:	http://gala.gre.ac.uk/id/eprint/35726

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