Abstract
Backgroundsub-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.MethodsSix 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.ResultsSeventeen 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.ConclusionsEfforts 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.Trial registrationSystematic review registration: PROSPERO registration CRD42018114261.
Highlights
Referral to an appropriate health facility to address maternity needs is a key indicator of a functional health system [1, 2]
High quality referral is critical in low and lower-middle income countries (LLMICs) to prevent severe maternal morbidity that occurs in 8% of births in health facilities [4, 5]
In subSaharan Africa, obstructed labour, hypertensive disorders, unsafe abortion, sepsis and haemorrhage are the principal causes of maternal morbidity [6]
Summary
Referral to an appropriate health facility to address maternity needs is a key indicator of a functional health system [1, 2]. High quality referral is critical in low and lower-middle income countries (LLMICs) to prevent severe maternal morbidity that occurs in 8% of births in health facilities [4, 5]. Multisectoral collaboration and well-coordinated levels of care, linking communities with essential maternal and newborn care is a necessary component of a high-quality referral system. Poor detection and treatment delays of complications is a major cause of maternal and perinatal mortality in LLMICs, in sSA [7] where efforts are focused on improving standards of maternal and newborn referral [8, 9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
