ArticleBMC pediatrics2020
Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment.
Article in BMC pediatrics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis 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
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.
- Systematic review of the quality of care provided to sick children in Ethiopian health facilities.Journal of global health · 2024Pooled it
- Pathways of emergency care for severely ill children in Nigerian and Ugandan hospitals: A process mapping study.PLoS medicine · 2026Article
- Structural Quality of Institutional Delivery Services at Public Health Facilities in North-West Ethiopia: A Mixed Study.Health science reports · 2026Article
- Neonatal complications and referral practices at birth: insights from a population-based study in the Indian state of Bihar.BMJ open · 2025Article
- Health post readiness and its influence on mothers' care-seeking practice for their sick children in Ethiopia.Frontiers in public health · 2025Article
- Barriers and enablers of quality high-acuity neonatal care in sub-Saharan Africa: protocol for a synthesis of qualitative evidence.BMJ open · 2024Article
- Neonatal transport practices and effectiveness of the use of low-cost interventions on outcomes of transported neonates in Sub-Saharan Africa: A systematic review and narrative synthesis.Health science reports · 2024Article
- Article
- How long should young infants less than two months of age with moderate-mortality-risk signs of possible serious bacterial infection be hospitalised for? Study protocol for a randomised controlled trial from low- and middle-income countries.Journal of global health · 2023Article
- Optimal place of treatment for young infants aged less than two months with any low-mortality-risk sign of possible serious bacterial infection: Study Protocol for a randomised controlled trial from low- and middle-income countries.Journal of global health · 2023Article
- The five continuum of care criteria that should accompany rectal artesunate interventions: lessons learned from an implementation study in Malawi.Malaria journal · 2023Article
- Timing of perinatal death; causes, circumstances, and regional variations among reviewed deaths in Ethiopia.PloS one · 2023Article
- Assessment of neonatal referral infrastructure and clinical characteristics of referred neonates in three first referral hospitals in Nairobi County, Kenya.Wellcome open research · 2023Article
- Review
- Cause and risk factors of early neonatal death in Ethiopia.PloS one · 2022Article
- Observational
- Readiness to Provide Antenatal Corticosteroids for Threatened Preterm Birth in Public Health Facilities in Northern India.Global health, science and practice · 2021Article
- A mixed-methods study exploring adherence to the referral of severely sick children in primary health care in Southern Ethiopia.Archives of public health = Archives belges de sante publique · 2021Article
- Clinical signs of possible serious infection and associated mortality among young infants presenting at first-level health facilities.PloS one · 2021Article
- Assessing Facilitators and Barriers to Referral of Children Under the Age of Five Years at Ndirande Health Centre in Blantyre, Malawi.Global pediatric health · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundA 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.
methodsA 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.
resultsGaps 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.
conclusionsAs 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.
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.