The quality of and women’s satisfaction with maternal referral practices in Sub-Saharan African low and lower-middle income countries: A systematic review.

Research Square
Publication Type:
Journal Article
BMC P, 2020, Accepted for publication
Issue Date:
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Abstract Background: Sub-Saharan African Low and Lower-Middle Income Countries (SSA LLMICs have the highest burden of maternal and neonatal morbidity and mortality in the world. Timely and appropriate obstetric referral to a suitable health facility is a sign of effective health system. This paper presents the findings of a systematic review that aimed to identify what referral practices are delivered according to accepted standards for pregnant women and newborns in SSA LLMICs by competent healthcare providers and in line with the need and wishes of 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. The articles defined quality referral as: the timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers at 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 of the articles (10) reported that women were not accompanied to higher levels of healthcare, delays in referral processes, transportation 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 maternal healthcare providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate transportation barriers of referral. To ensure quality maternal referral, mechanisms should be instituted for health managers at the district level to monitor and evaluate referral documentation, quality and efficiency of maternal referrals on regular basis.
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