SynthesisTropical medicine & international health : TM & IH2022
Interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub-Saharan Africa: A systematic review.
Synthesis in Tropical medicine & international health : TM & IH, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
What it found
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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.
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Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Prevalence, indications, and complications of caesarean section in health facilities across Nigeria: a systematic review and meta-analysis.Reproductive health · 2023Pooled 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
- Evaluating the Effects of a Mobile Obstetric Emergency System on Healthcare Providers' Communication and Relationships in Bong County, Liberia.Healthcare (Basel, Switzerland) · 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
- Cross-context qualitative synthesis of a mobile obstetric referral emergency system (MORES) in Ghana and Liberia.PloS one · 2026Article
- Maternal and Neonatal Mortality in Somalia: A Persistent Women's Health Crisis Requiring Primary Health Care and Community Health System Reform.International journal of women's health · 2026Article
- Understanding Antecedents and Attributes in the Context of Upward Referral for Obstetric Emergencies: A Grounded Theory Study.F1000Research · 2026Article
- Strategies to improve outcomes of obstetric emergencies in sub-Saharan Africa: A scoping review.PloS one · 2026Article
- Maternal healthcare quality, continuity, and experiences among pregnant adolescents and adult women in Ethiopia, Kenya, and South Africa: A cohort study.PLOS global public health · 2026Article
- Reporting maternal deaths in Anglophone West Africa: A media content analysis of articles published online between 2015 and 2025.PLOS global public health · 2026Article
- Closing the Referral Gap During Prolonged Labour in Somalia: From Traditional Birth Attendance to Emergency Obstetric Care.International journal of women's health · 2026Article
- Research and Learning Priorities for a Surgical Obstetrics and Family Planning Project Implementing in Low- and Middle-Income Countries: Results of an Expert Consultation.Global health, science and practice · 2025Article
- Optimizing people's movement across the health system: a scoping review of referral systems within a primary health care approach.Primary health care research & development · 2025Article
- Improving Decision-to-Incision Interval (DDI) of Emergency Cesarean Sections Through Mobile-Based Obstetric Emergency System (MORES) and Midwife-Led Triage in Bong County, Liberia: A Quasi-Experimental Study.International journal of environmental research and public health · 2025Article
- Article
- Pelvic packing as a life-saving intervention in the referral of patients with obstetric hemorrhage: comparing outcomes in referred and non-referred patients.BMC pregnancy and childbirth · 2025Observational
- 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
- Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia.JMIR mHealth and uHealth · 2024Article
- Socio-spatial equity analysis of relative wealth index and emergency obstetric care accessibility in urban Nigeria.Communications medicine · 2024Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe objective of the study was to review the evidence on interventions to improve obstetric emergency referral decision making, communication and feedback between health facilities in sub-Saharan Africa (SSA).
methodsA systematic search of PubMed, Embase, Cochrane Register and CINAHL Plus was conducted to identify studies on obstetric emergency referral in SSA. Studies were included based on pre-defined eligibility criteria. Details of reported referral interventions were extracted and categorised. The Joanna Biggs Institute Critical Appraisal checklists were used for quality assessment of included studies. A formal narrative synthesis approach was used to summarise findings guided by the WHO's referral system flow.
resultsA total of 14 studies were included, with seven deemed high quality. Overall, 7 studies reported referral decision-making interventions including training programmes for health facility and community health workers, use of a triage checklist and focused obstetric ultrasound, which resulted in improved knowledge and practice of recognising danger signs for referral. 9 studies reported on referral communication using mobile phones and referral letters/notes, resulting in increased communication between facilities despite telecommunication network failures. Referral decision making and communication interventions achieved a perceived reduction in maternal mortality. 2 studies focused on referral feedback, which improved collaboration between health facilities.
conclusionThere is limited evidence on how well referral interventions work in sub-Saharan Africa, and limited consensus regarding the framework underpinning the expected change. This review has led to the proposition of a logic model that can serve as the base for future evaluations which robustly expose the (in)efficiency of referral interventions.
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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.