ArticleBMJ open2019
Completeness of obstetric referral letters/notes from subdistrict to district level in three rural districts in Greater Accra region of Ghana: an implementation research using mixed methods.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub-Saharan Africa: A systematic review.Tropical medicine & international health : TM & IH · 2022Pooled it
- Effectiveness of Communication Interventions in Obstetrics-A Systematic Review.International journal of environmental research and public health · 2021Pooled it
- AI-enabled obstetric point-of-care ultrasound as an emerging technology in low- and middle-income countries: provider and health system perspectives.BMC pregnancy and childbirth · 2025Article
- Implementation of antepartum preterm birth interventions: A scoping review.European journal of obstetrics & gynecology and reproductive biology: X · 2025Review
- Appropriateness of maternal referral system and its associated factors in Eastern Ethiopia: a facility-based cross-sectional study.Frontiers in global women's health · 2025Article
- Article
- Referral Audit of Critically Ill Obstetric Patients: A Five-year Review from a Tertiary Care Health Facility in India.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024Article
- Article
- Assessment of formats and completeness of paper-based referral letters among urban hospitals in Rwanda: a retrospective baseline study.BMC health services research · 2022Article
- Obstetric referral processes and the role of inter-facility communication: the district-level experience in the Greater Accra region of Ghana.Ghana medical journal · 2022Article
- Audit of documentation accompanying referred maternity cases to a referral hospital in northern Ghana: a mixed-methods study.BMC health services research · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the completeness of obstetric referral letters/notes at the district level of healthcare.
designAn implementation research within three districts in Greater Accra region using mixed methods. During baseline and intervention phases, referral processes for all obstetric referrals from lower level facilities seen at the district hospitals were documented including indications for referrals, availability and completeness of referral notes/forms. An assessment of before and after intervention availability and completeness of referral forms was carried out. Focus group discussions, non-participant observations and in-depth interviews with health workers and pregnant women were conducted for qualitative data.
settingThree (3) districts in the Greater Accra region of Ghana.
participantsPregnant women referred from lower levels of care to and seen at the district hospital, health workers within the three districts and pregnant women attending antenatal clinic in the district and their family members or spouses.
interventionAn enhanced interfacility referral communication system consisting of training, provision of communication tools for facilities, formation of hospital referral teams and strengthening feedback mechanisms. OUTCOME: Completeness of obstetric referral letters/notes.
resultsProportion of obstetric referrals with referral notes improved from 27.2% to 44.3% from the baseline to intervention period. Mean completeness (95% CI) of all forms was 71.3% (64.1% to 78.5%) for the study period, improving from 70.7% (60.4% to 80.9%) to 71.9% (61.1% to 82.7%) from baseline to intervention periods. Health workers reported they do not always provide referral notes and that most referral notes are not completely filled due to various reasons.
conclusionsMost obstetric referrals did not have referral notes. The few notes provided were not completely filled. Interventions such as training of health workers, regular review of referral processes and use of electronic records can help improve both the provision of and completeness of the referral notes.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.