SynthesisBMC pregnancy and childbirth2020
Quality and women's satisfaction with maternal referral practices in sub-Saharan African low and lower-middle income countries: a systematic review.
Synthesis in BMC pregnancy and childbirth, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 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
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- 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
- Experiences of Health Facility Childbirth in Sub-Saharan Africa: A Systematic Review of Qualitative Evidence.Maternal and child health journal · 2022Pooled it
- The relationship between prolonged travel and mortality among women with complicated deliveries in rural Kenya.Journal of global health · 2026Article
- Multistakeholder perspectives on geographical accessibility to emergency obstetric care in Benin City, Nigeria.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2026Article
- Levels of care for maternal and neonatal healthcare: a scoping review.Journal of global health · 2026Article
- The Six Delays Model: expanding the three delays model with evidence from Madagascar for maternal referrals in LMICs.BMJ global health · 2026Review
- Closing the Referral Gap During Prolonged Labour in Somalia: From Traditional Birth Attendance to Emergency Obstetric Care.International journal of women's health · 2026Article
- Comparing the risk of maternal and perinatal complications among women with hypertensive disorders of pregnancy to normotensive women: an institution-based cohort review in Kenya.BMC pregnancy and childbirth · 2025Article
- Iranian Women's Experiences of Unintended Pregnancy and Induced Abortion: A Meta-Synthesis Study.Iranian journal of medical sciences · 2025Review
- Article
- Characterizing the referral care continuum among complex obstetric patients in the Blantyre District of Malawi: A mixed methods study.PLOS global public health · 2025Article
- Perceptions and experiences of women referred during obstetric complications in Eastern Uganda: A qualitative study.PLOS global public health · 2025Article
- Inequalities in geographical access to emergency obstetric and newborn care.Bulletin of the World Health Organization · 2024Article
- 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
- External Vs Internal e-Referrals: Results from a Nationwide Epidemiological Study Utilizing Secondary Collected Data.Risk management and healthcare policy · 2024Article
- Challenges of health workers in primary health facilities in implementing obstetric emergency referrals to save women from death in Indonesia: A qualitative study.Belitung nursing journal · 2024Article
- Article
- Impacts of seasonal flooding on geographical access to maternal healthcare in the Barotse Floodplain, Zambia.International journal of health geographics · 2023Article
- Acceptability of a Whatsapp Triage, Referral, and Transfer System for Obstetric Patients in Rural Liberia.Annals of global health · 2023Article
- Emergency obstetric referrals in public health facilities: A descriptive study from urban Maharashtra, India.Frontiers in health services · 2023Article
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 at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundsub-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.
methodsSix 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.
resultsSeventeen 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.
conclusionsEfforts 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 registrationSystematic review registration: PROSPERO registration CRD42018114261 .
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.