scholarly journals The quality of and women’s satisfaction with maternal referral practices in Sub-Saharan African low and lower-middle income countries: A systematic review

2019 ◽  
Author(s):  
Edward Kwabena Ameyaw ◽  
Carolyne Njue ◽  
Nguyen Toan Tran ◽  
Angela Dawson
Keyword(s):  
Systematic Review ◽  
Healthcare Providers ◽  
Neonatal Morbidity ◽  
Primary Data ◽  
Middle Income ◽  
Signal Functions ◽  
Middle Income Countries ◽  
Referral Practices ◽  
Sub Saharan

Abstract Background: Sub-Saharan African Low and Lower-Middle Income Countries (SSA LLMICs have the highest burden of maternal and neonatal morbidity and mortality in the world. Timely and appropriate obstetric referral to a suitable health facility is a sign of effective health system. This paper presents the findings of a systematic review that aimed to identify what referral practices are delivered according to accepted standards for pregnant women and newborns in SSA LLMICs by competent healthcare providers and in line with the need and wishes of women. Methods: Six electronic databases were systematically searched for primary data studies (2009-2018) in English reporting on maternal referral practices and effectiveness. We conducted a content analysis of data in the findings of each paper guided by a framework for assessing the quality of maternal referral. Results: Seventeen articles were included in the study. Most studies were quantitative (n=11). Quality maternal referral was defined as occurring as a result of: the timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers at the receiving facility. Two studies reported that women were dissatisfied due to delays in referral processes that affected their health. We found lack of accompaniment to upper levels of healthcare, delays in referral processes, transportation challenges and poor documentation of referral cases. Some healthcare providers administered essential drugs such as misoprostol prior to referral. Conclusions: Efforts to improve maternal health in LLMICs should aim to enhance maternal healthcare providers’ ability to identify signal functions that are integral to referral. Low cost transport is needed to mitigate transportation barriers to referral. To ensure quality maternal referral, mechanisms should be instituted for health managers at the district level to monitor and evaluate referral documentation, quality and efficiency of maternal referrals on regular basis.

scholarly journals The quality of and women’s satisfaction with maternal referral practices in Sub-Saharan African low and lower-middle income countries: A systematic review

2020 ◽  
Author(s):  
Edward Kwabena Ameyaw ◽  
Carolyne Njue ◽  
Nguyen Toan Tran ◽  
Angela Dawson
Keyword(s):  
Systematic Review ◽  
Low Cost ◽  
Healthcare Providers ◽  
Neonatal Morbidity ◽  
Primary Data ◽  
Middle Income ◽  
Middle Income Countries ◽  
Referral Practices ◽  
Sub Saharan

Abstract Background: Sub-Saharan African Low and Lower-Middle Income Countries (SSA LLMICs have the highest burden of maternal and neonatal morbidity and mortality in the world. Timely and appropriate obstetric referral to a suitable health facility is a sign of effective health system. This paper presents the findings of a systematic review that aimed to identify what referral practices are delivered according to accepted standards for pregnant women and newborns in SSA LLMICs by competent healthcare providers and in line with the need and wishes of women. Methods: Six 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. The articles defined quality referral as: the timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers at the receiving facility. Results: Seventeen 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 of the articles (10) reported that women were not accompanied to higher levels of healthcare, delays in referral processes, transportation challenges and poor referral documentation. Some healthcare providers administered essential drugs such as misoprostol prior to referral. Conclusions: Efforts to improve maternal health in LLMICs should aim to enhance maternal healthcare providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate transportation barriers of referral. To ensure quality maternal referral, mechanisms should be instituted for health managers at the district level to monitor and evaluate referral documentation, quality and efficiency of maternal referrals on regular basis.

scholarly journals The quality of and women’s satisfaction with maternal referral practices in Sub-Saharan African low and lower-middle income countries: A systematic review

2020 ◽  
Author(s):  
Edward Kwabena Ameyaw ◽  
Carolyne Njue ◽  
Nguyen Toan Tran ◽  
Angela Dawson
Keyword(s):  
Systematic Review ◽  
Low Cost ◽  
Healthcare Providers ◽  
Neonatal Morbidity ◽  
Primary Data ◽  
Middle Income ◽  
Middle Income Countries ◽  
Referral Practices ◽  
Sub Saharan

Abstract Background: Sub-Saharan African Low and Lower-Middle Income Countries (SSA LLMICs have the highest burden of maternal and neonatal morbidity and mortality in the world. Timely and appropriate obstetric referral to a suitable health facility is a sign of effective health system. This paper presents the findings of a systematic review that aimed to identify what referral practices are delivered according to accepted standards for pregnant women and newborns in SSA LLMICs by competent healthcare providers and in line with the need and wishes of women. Methods: Six 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. The articles defined quality referral as: the timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers at the receiving facility. Results: Seventeen 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 of the articles (10) reported that women were not accompanied to higher levels of healthcare, delays in referral processes, transportation challenges and poor referral documentation. Some healthcare providers administered essential drugs such as misoprostol prior to referral. Conclusions: Efforts to improve maternal health in LLMICs should aim to enhance maternal healthcare providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate transportation barriers of referral. To ensure quality maternal referral, mechanisms should be instituted for health managers at the district level to monitor and evaluate referral documentation, quality and efficiency of maternal referrals on regular basis.

scholarly journals Quality and women’s satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: A systematic review 

2020 ◽  
Author(s):  
Edward Kwabena Ameyaw ◽  
Carolyne Njue ◽  
Nguyen Toan Tran ◽  
Angela Dawson
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Low Cost ◽  
Healthcare Providers ◽  
Primary Data ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Referral Practices ◽  
Sub Saharan

Abstract Background: sub-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.Methods: Six 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.Results: Seventeen 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.Conclusions: Efforts 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. Systematic review registration: PROSPERO registration CRD42018114261

scholarly journals Quality and women’s satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: a systematic review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Edward Kwabena Ameyaw ◽  
Carolyne Njue ◽  
Nguyen Toan Tran ◽  
Angela Dawson
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Low Cost ◽  
Healthcare Providers ◽  
Primary Data ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Referral Practices ◽  
Sub Saharan

Abstract Background sub-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. Methods Six 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. Results Seventeen 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. Conclusions Efforts 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 registration Systematic review registration: PROSPERO registration CRD42018114261.

scholarly journals Pattern of Severity of Road Traffic Injuries Among Pedestrians in Low- and Middle-Income Countries: A Systematic Review

2021 ◽  
Author(s):  
Neeraj Sharma ◽  
Mohan Bairwa ◽  
S. D. Gupta ◽  
D. K. Mangal
Keyword(s):  
Systematic Review ◽  
Injury Severity ◽  
Road Traffic ◽  
Sub Saharan Africa ◽  
Middle Income ◽  
Road Traffic Injuries ◽  
Middle Income Countries ◽  
Sub Saharan ◽  
Low And Middle Income

ABSTRACTBackgroundLow-and middle-income countries (LMICs) contribute about 93 per cent of road traffic injuries (RTIs) and deaths worldwide with a significant proportion of pedestrians (22 per cent). Various scales are used to assess the pattern of injury severity, which are useful in predicting the outcomes of RTIs. We conducted this systematic review to determine the pattern of RTI severity among pedestrians in LMICs.MethodsWe searched the electronic databases PubMed, CINHAL, CENTRAL, Web of Science, Scopus, EMBASE, ProQuest and SciELO, and examined the references of the selected studies. Original research articles published on the RTI severity among pedestrians in LMICs during 1997-2016 were eligible for this review. Quality of publications was assessed using an adapted Newcastle-Ottawa Scale of observational studies. Findings of this study were presented as a meta-summary.ResultsFive articles from 3 LMICs were eligible for the systematic review. Abbreviated Injury Score, Glasgow Coma Scale and Maxillofacial Injury Severity Score were used to assess the injury severity in the selected studies. In a multicentric study from China (2013), 21, 38 and 19 per cent pedestrians with head injuries had AIS scores 1-2, 3-4 and 5-6, respectively. In another study from China (2010), the proportion of AIS score 1-2 and AIS score 3 and above (serious to un-survivable) injuries occurred due to crash with sedan cars were 65 and 35 per cent, respectively. Such injuries due to minivan crashes were 49.5 per cent and 50.5 per cent, respectively. Two studies Ikeja, Nigeria (2014) and Elazig, Turkey (2009) presented, 24.5 and 32.5 per cent injured had a severe head injury (GCS < 8), respectively. In another study from Ibadan, Nigeria (2014), the severe maxillofacial injuries were seen in the victims of car/minibus pedestrian crashes 46 per cent, and 17 per cent had a fatal outcome.ConclusionA varied percent of pedestrians (24.5 to 57 percent) had road traffic injuries of serious to fatal nature, depending on type of collision and injury severity scale. This study pressed the need to conduct studies with a robust methodology on the pattern of RTI severity among pedestrians to guide the programme managers, researchers and policymakers in LMICs to formulate the policies and programmes to save the pedestrian lives.African relevancePrior RTI research reveals that pedestrians and cyclists were at the highest risk of fatality of in Sub-Saharan Africa, whereas motorcyclists had significantly higher fatality rates in Asian countries such as Malaysia and Thailand (1–3).Fifty-seven type of injury severity scoring systems have been developed to assess the injury severity for triage and timely decision making for patient treatment need, outcome prediction, quality of trauma care, and epidemiological research and evaluation (4,5).We found two studies from sub-Saharan Africa in this review which showed that severe pedestrian injuries ranged from 24.5 to 46 per cent of total pedestrian RTIs.Despite the findings of review affected by limited and variegated sample, it could be useful to guide for future research.

scholarly journals Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review

2021 ◽  
Vol 6 (2) ◽  
pp. e004213
Author(s):  
Grace McCutchan ◽  
Bahr Weiss ◽  
Harriet Quinn-Scoggins ◽  
Anh Dao ◽  
Tom Downs ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Cancer Treatment ◽  
Help Seeking ◽  
Middle Income ◽  
Cancer Symptoms ◽  
Middle Income Countries ◽  
Help Seeking Behaviour ◽  
Psychosocial Influences

IntroductionStarting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment.MethodsMixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate.ResultsOf 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments.ConclusionDue to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.

scholarly journals Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mamuda Aminu ◽  
Sarah Bar-Zeev ◽  
Sarah White ◽  
Matthews Mathai ◽  
Nynke van den Broek
Keyword(s):  
Sierra Leone ◽  
Cause Of Death ◽  
Expert Panel ◽  
Healthcare Providers ◽  
Sub Saharan Africa ◽  
Primary Data ◽  
Middle Income ◽  
Computer Based ◽  
Sub Saharan ◽  
Low And Middle Income

Abstract Background Every year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). There is a paucity of primary data on cause of stillbirth from LMIC, and particularly from sub-Saharan Africa to inform effective interventions. This study aimed to identify the cause of stillbirths in low- and middle-income settings and compare methods of assessment. Methods This was a prospective, observational study in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. Stillbirths (28 weeks or more) were reviewed to assign the cause of death by healthcare providers, an expert panel and by using computer-based algorithms. Agreement between the three methods was compared using Kappa (κ) analysis. Cause of stillbirth and level of agreement between the methods used to assign cause of death. Results One thousand five hundred sixty-three stillbirths were studied. The stillbirth rate (per 1000 births) was 20.3 in Malawi, 34.7 in Zimbabwe, 38.8 in Kenya and 118.1 in Sierra Leone. Half (50.7%) of all stillbirths occurred during the intrapartum period. Cause of death (range) overall varied by method of assessment and included: asphyxia (18.5–37.4%), placental disorders (8.4–15.1%), maternal hypertensive disorders (5.1–13.6%), infections (4.3–9.0%), cord problems (3.3–6.5%), and ruptured uterus due to obstructed labour (2.6–6.1%). Cause of stillbirth was unknown in 17.9–26.0% of cases. Moderate agreement was observed for cause of stillbirth as assigned by the expert panel and by hospital-based healthcare providers who conducted perinatal death review (κ = 0.69; p < 0.0005). There was only minimal agreement between expert panel review or healthcare provider review and computer-based algorithms (κ = 0.34; 0.31 respectively p < 0.0005). Conclusions For the majority of stillbirths, an underlying likely cause of death could be determined despite limited diagnostic capacity. In these settings, more diagnostic information is, however, needed to establish a more specific cause of death for the majority of stillbirths. Existing computer-based algorithms used to assign cause of death require revision.

scholarly journals Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review

BJPsych Open ◽  
2018 ◽  
Vol 4 (5) ◽  
pp. 375-384 ◽  
Author(s):  
Mekdes Demissie ◽  
Charlotte Hanlon ◽  
Rahel Birhane ◽  
Lauren Ng ◽  
Girmay Medhin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Bipolar Disorder ◽  
Low Income ◽  
Hospital Admissions ◽  
Psychological Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

BackgroundAdjunctive psychological interventions for bipolar disorder have demonstrated better efficacy in preventing or delaying relapse and improving outcomes compared with pharmacotherapy alone.AimsTo evaluate the efficacy of psychological interventions for bipolar disorder in low- and middle-income countries.MethodA systematic review was conducted using PubMed, PsycINFO, Medline, EMBASE, Cochrane database for systematic review, Cochrane central register of controlled trials, Latin America and Caribbean Center on Health Science Literature and African Journals Online databases with no restriction of language or year of publication. Methodological heterogeneity of studies precluded meta-analysis.ResultsA total of 18 adjunctive studies were identified: psychoeducation (n = 14), family intervention (n = 1), group cognitive–behavioural therapy (CBT) (n = 2) and group mindfulness-based cognitive therapy (MBCT) (n = 1). In total, 16 of the 18 studies were from upper-middle-income countries and none from low-income countries. All used mental health specialists or experienced therapists to deliver the intervention. Most of the studies have moderately high risk of bias. Psychoeducation improved treatment adherence, knowledge of and attitudes towards bipolar disorder and quality of life, and led to decreased relapse rates and hospital admissions. Family psychoeducation prevented relapse, decreased hospital admissions and improved medication adherence. CBT reduced both depressive and manic symptoms. MBCT reduced emotional dysregulation.ConclusionsAdjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries. Further studies are required to investigate contextual adaptation and the role of non-specialists in the provision of psychological interventions to ensure scalability and the efficacy of these interventions in low-income country settings.Declaration of interestNone.

scholarly journals Reforming medical education admission and training in low- and middle-income countries: who gets admitted and why it matters

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Katherine Tumlinson ◽  
Dilshad Jaff ◽  
Barbara Stilwell ◽  
Dickens Otieno Onyango ◽  
Kenneth L. Leonard
Keyword(s):  
Medical Education ◽  
Intrinsic Motivation ◽  
Healthcare Providers ◽  
Extrinsic Factors ◽  
Middle Income ◽  
Negative Behaviors ◽  
Middle Income Countries ◽  
And Training ◽  
Low And Middle Income

AbstractRecent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation.

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