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Norms for scaling up small and sick newborn care: an overview of reviews
Natalie A Strobel1, Georgia Whisson1, Derek Swe1
1Edith Cowan University, Kurongkurl Katitjin, Perth, Australia.
Insights
Systematic reviews on scaling up care for small and sick newborns (SSN) are lacking, especially regarding hospital bed norms. Current evidence on space, workforce, and travel time for SSN services in low- and middle-income countries has a high risk of bias.
Area of Science:
- Neonatal care research
- Public health policy
- Evidence synthesis
Background:
- Global health organizations lack benchmarks for scaling small and sick newborn (SSN) services in low- and middle-income countries (LMICs).
- Key areas for scaling up SSN care include hospital bed availability, unit space, healthcare workforce, and patient travel time.
- Understanding existing systematic reviews is crucial for developing evidence-based guidelines.
Purpose of the Study:
- To identify systematic reviews addressing norms for scaling up small and sick newborn (SSN) services in LMICs.
- To assess the availability of evidence on SSN bed, space, workforce, and travel time norms.
- To evaluate the quality and scope of existing systematic reviews in the last five years.
Main Methods:
- Searched for systematic reviews published between 2018-2023 on SSN norms (beds, space, workforce, travel time).
- Included reviews of prevalence, incidence, mean, median estimates for beds, space, and workforce.
- Included reviews of effect estimates (dichotomous or continuous) for travel time.
Main Results:
- Eight systematic reviews were included, focusing on space (2), workforce (5), and travel time (1); no reviews were found for bed norms.
- Reviews often focused on high-income countries or tertiary neonatal intensive care units.
- Seven of the eight reviews had a high risk of bias, limiting the reliability of findings on SSN space, workforce, and travel time.
Conclusions:
- There is a significant gap in rigorous systematic reviews for scaling up SSN care in LMICs.
- The World Health Organization and UNICEF have commissioned new systematic reviews to address these evidence gaps.
- Future steps include analyzing country-level data and developing implementation guidance for SSN services.
Background:
The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) currently have no benchmarks or 'norms' for scaling up small and sick newborn (SSN) service delivery in health facilities in low- and middle-income countries (LMICs). Our objective was to understand which systematic reviews had addressed the following norms in the last five years: number of SSN beds per live births in a district or similar administrative unit (admission beds); space requirements for SSN units, including mother-infant dyads (space); health workforce ratios in SSN units (workforce); and travel time to health facilities with SSN units (travel time).
Methods:
We searched for systematic reviews of admission beds, space, workforce and travel time norms for SSN under 28 days of age and their mothers in all health facilities and countries, regardless of infant gestational age and birth weight, that had been published in the previous five years (2018-23). For beds, space, and workforce norms, we searched for reviews of prevalence, incidence, mean and median estimates. For the travel time norm, we searched for reviews of estimates of effect, i.e. dichotomous (e.g. relative risks) or continuous measures (e.g. mean differences).
Results:
We identified 9110 records and included eight systematic reviews published in the last five years: two related to space, five to workforce, and one to travel time norms. We found no reviews for admission bed norms. Two reviews included high income countries only, while three included tertiary neonatal intensive care units only. The reviews provided estimates of mean space requirements in SSN units, health workforce ratios of doctors and nurses, and optimal travel time to health facilities for SSN. Seven of the eight reviews had high risk of bias.
Conclusions:
Despite the high burden of SSN in LMICs and the need to scale up hospital care, there have been few systematic reviews into this topic, and rigorous syntheses of evidence are lacking. The WHO and the UNICEF have now commissioned four systematic reviews. The next steps will be to analyse real-world country-level data and develop implementation guidance.
Registration:
PROSPERO: CRD42023417847, CRD42023451302, CRD42023478512, CRD42023453644.
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