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Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment
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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456368/ https://www.ncbi.nlm.nih.gov/pubmed/32861246 http://dx.doi.org/10.1186/s12887-020-02311-6 |
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author | Teklu, Alula M. Litch, James A. Tesfahun, Alemu Wolka, Eskinder Tuamay, Berhe Dessalegn Gidey, Hagos Cheru, Wondimye Ashenafi Senturia, Kirsten Gezahegn, Wendemaghen |
author_facet | Teklu, Alula M. Litch, James A. Tesfahun, Alemu Wolka, Eskinder Tuamay, Berhe Dessalegn Gidey, Hagos Cheru, Wondimye Ashenafi Senturia, Kirsten Gezahegn, Wendemaghen |
author_sort | Teklu, Alula M. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7456368 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-74563682020-08-31 Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment Teklu, Alula M. Litch, James A. Tesfahun, Alemu Wolka, Eskinder Tuamay, Berhe Dessalegn Gidey, Hagos Cheru, Wondimye Ashenafi Senturia, Kirsten Gezahegn, Wendemaghen BMC Pediatr Research Article 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. BioMed Central 2020-08-29 /pmc/articles/PMC7456368/ /pubmed/32861246 http://dx.doi.org/10.1186/s12887-020-02311-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Teklu, Alula M. Litch, James A. Tesfahun, Alemu Wolka, Eskinder Tuamay, Berhe Dessalegn Gidey, Hagos Cheru, Wondimye Ashenafi Senturia, Kirsten Gezahegn, Wendemaghen Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment |
title | Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment |
title_full | Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment |
title_fullStr | Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment |
title_full_unstemmed | Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment |
title_short | Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment |
title_sort | referral systems for preterm, low birth weight, and sick newborns in ethiopia: a qualitative assessment |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456368/ https://www.ncbi.nlm.nih.gov/pubmed/32861246 http://dx.doi.org/10.1186/s12887-020-02311-6 |
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