Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment
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RESEARCH ARTICLE
Open Access
Referral systems for preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment Alula M. Teklu1, James A. Litch2* , Alemu Tesfahun3, Eskinder Wolka4, Berhe Dessalegn Tuamay5, Hagos Gidey6, Wondimye Ashenafi Cheru7, Kirsten Senturia2, Wendemaghen Gezahegn1 and And the Every Preemie–SCALE Ethiopia Implementation Research Collaboration Group
Abstract Background: A 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. Methods: A 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. Results: Gaps 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. Conclusions: As 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. Keywords: Referral and consultation, Premature infant, Premature birth, Low birth weight, Newborn, Newborn health, Ethiopia
* Correspondence: [email protected]; [email protected] 2 Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), 19009 33rd Avenue W, Suite 200, Lynnwood, Seattle, WA 98036, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the
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