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Building referral mechanisms for neonatal care in humanitarian emergency settings: A systematic review
Spencer Rutherford1, Maryan Naman2, Nabila Zaka3
1Population, Policy Practice Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
Insights
Humanitarian emergencies increase neonatal mortality. Improving referral systems through community healthcare worker training and education programs is crucial for addressing gaps in neonatal care during crises.
Area of Science:
- Global Health
- Emergency Medicine
- Neonatal Care
Background:
- Humanitarian emergencies exacerbate maternal and neonatal health risks, increasing mortality rates.
- Coordination of health referrals for neonates is a significant challenge in crisis settings.
- This review identifies critical referral needs, gaps, and barriers for neonates during humanitarian emergencies.
Approach:
- A systematic review of 4 electronic databases (CINAHL, EMBASE, Medline, Scopus) was conducted.
- Included studies focused on neonates in humanitarian emergencies, excluding high-income countries and pre-1991 research.
- Risk of bias was assessed using the STROBE checklist.
Key Points:
- Primary neonatal referral needs include pre- and post-labor transfers to health facilities.
- Barriers to effective referrals encompass infrastructure deficits, transport limitations, and specialized staff shortages.
- Patient knowledge gaps for self-referral also pose a significant challenge.
Conclusions:
- Capacity-building programs for local healthcare workers are essential.
- Community healthcare workers (CHWs) play a vital role in raising awareness and providing timely neonatal care.
- Upskilling CHWs is recommended to ensure appropriate and quality neonatal care during humanitarian crises.
Aim:
During humanitarian emergencies, women and children are particularly vulnerable to health complications and neonatal mortality rates have been shown to rise. Additionally, health cluster partners face challenges in coordinating referrals, both between communities and camps to health facilities and across different levels of health facilities. The purpose of this review was to identify the primary referral needs of neonates during humanitarian emergencies, current gaps and barriers, and effective mechanisms for overcoming these barriers.
Methods:
A systematic review was performed using four electronic databases (CINAHL, EMBASE, Medline, and Scopus) between June and August 2019 (PROSPERO registration number CRD42019127705). Title, abstract, and full text screening were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The target population was neonates born during humanitarian emergencies. Studies from high-income countries and prior to 1991 were excluded. The STROBE checklist was used to assess for risk of bias.
Results:
A total of 11 articles were included in the analysis; these were mainly cross-sectional, field-based studies. The primary needs identified were referrals from homes to health facilities before and during labour, and inter-facility referrals after labour to more specialised services. Some of the main barriers included a lack of roads and infrastructure for transport, staff shortages-especially among more specialised services, and a lack of knowledge among patients for self-referral. Mechanisms for addressing these needs and gaps included providing training for community healthcare workers (CHWs) or traditional birth attendants to identify and address antenatal and post-natal complications; education programmes for pregnant women during the antenatal period; and establishing ambulance services in partnership with local Non-Governmental Organizations.
Conclusion:
This review benefited from a strong consensus among selected studies but was limited in the quality of data and types of data that were reported. Based on the above findings, the following recommendations were compiled: Focus on local capacity-building programmes to address programmes acutely. Recruit CHWs to raise awareness of neonatal complications among pregnant women. Upskill CHWs to provide timely, appropriate and quality care during humanitarian emergencies.
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