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Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment
Alula M Teklu1, James A Litch2, Alemu Tesfahun3
1St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Insights
Barriers in Ethiopia's newborn referral system include poor transport, communication gaps, and family reluctance. Addressing these requires government investment and improved primary care services to reduce newborn mortality.
Area of Science:
- Public Health
- Neonatal Care
- Health Systems Research
Background:
- Effective newborn referral systems are crucial for child healthcare continuity.
- Health system and client-related barriers impede referral system functionality.
- Limited research exists on the complexities of newborn referral processes.
Purpose of the Study:
- To assess barriers to the effective functioning of referral systems for preterm, low birth weight, and sick newborns in Ethiopian primary healthcare units.
- To identify challenges across diverse regions in Ethiopia.
Main Methods:
- Qualitative assessment utilizing interviews with mothers, facility leaders, and healthcare providers.
- Thematic content analysis of coded data from focus group discussions and interviews.
Main Results:
- Key barriers identified in transport, referral communication, protocol adherence, and family acceptance.
- Specific issues include lack of ambulances, uncoordinated communication, non-adherence to protocols, family fears, and high patient costs.
- These barriers were prevalent in both urban and rural settings.
Conclusions:
- Urgent government investment in newborn referral systems and standardized communication is needed.
- Improving primary healthcare services can reduce referral overload and enhance newborn care quality.
- Addressing identified barriers is essential for averting early child deaths in Ethiopia.
Background:
A responsive and well-functioning newborn referral system is a cornerstone to the continuum of child health care; however, health system and client-related barriers negatively impact the referral system. Due to the complexity and multifaceted nature of newborn referral processes, studies on newborn referral systems have been limited. The objective of this study was to assess the barriers for effective functioning of the referral system for preterm, low birth weight, and sick newborns across the primary health care units in 3 contrasting regions of Ethiopia.
Methods:
A qualitative assessment using interviews with mothers of preterm, low birth weight, and sick newborns, interviews with facility leaders, and focus group discussions with health care providers was conducted in selected health facilities. Data were coded using an iteratively developed codebook and synthesized using thematic content analysis.
Results:
Gaps and barriers in the newborn referral system were identified in 3 areas: transport and referral communication; availability of, and adherence to newborn referral protocols; and family reluctance or refusal of newborn referral. Specifically, the most commonly noted barriers in both urban and rural settings were lack of ambulance, uncoordinated referral and return referral communications between providers and between facilities, unavailability or non-adherence to newborn referral protocols, family fear of the unknown, expectation of infant death despite referral, and patient costs related to referral.
Conclusions:
As the Ethiopian Federal Ministry of Health focuses on averting early child deaths, government investments in newborn referral systems and standardizing referral and return referral communication are urgently needed. A complimentary approach is to lessen referral overload at higher-level facilities through improvements in the scope and quality of services at lower health system tiers to provide basic and advanced newborn care.
