Kozuki Naoko, Guenther Tanya, Vaz Lara, Moran Allisyn, Soofi Sajid B, Kayemba Christine Nalwadda, Peterson Stefan S, Bhutta Zulfiqar A, Khanal Sudhir, Tielsch James M, Doherty Tanya, Nsibande Duduzile, Lawn Joy E, Wall Stephen
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. W5019, Baltimore, MD, 21205, USA.
Save the Children, 2000 L Street NW, Suite 500, Washington, DC, 20036, USA.
BMC Public Health. 2015 Sep 30;15:989. doi: 10.1186/s12889-015-2330-0.
An estimated 2.8 million neonatal deaths occur annually worldwide. The vulnerability of newborns makes the timeliness of seeking and receiving care critical for neonatal survival and prevention of long-term sequelae. To better understand the role active referrals by community health workers play in neonatal careseeking, we synthesize data on referral completion rates for neonates with danger signs predictive of mortality or major morbidity in low- and middle-income countries.
A systematic review was conducted in May 2014 of the following databases: Medline-PubMed, Embase, and WHO databases. We also searched grey literature. In addition, an investigator group was established to identify unpublished data on newborn referral and completion rates. Inquiries were made to the network of research groups supported by Save the Children's Saving Newborn Lives project and other relevant research groups.
Three Sub-Saharan African and five South Asian studies reported data on community-to-facility referral completion rates. The studies varied on factors such as referral rates, the assessed danger signs, frequency of home visits in the neonatal period, and what was done to facilitate referrals. Neonatal referral completion rates ranged from 34 to 97 %, with the median rate of 74 %. Four studies reported data on the early neonatal period; early neonatal completion rates ranged from 46 to 97 %, with a median of 70 %. The definition of referral completion differed by studies, in aspects such as where the newborns were referred to and what was considered timely completion.
Existing literature reports a wide range of neonatal referral completion rates in Sub-Saharan Africa and South Asia following active illness surveillance. Interpreting these referral completion rates is challenging due to the great variation in study design and context. Often, what qualifies as referral and/or referral completion is poorly defined, which makes it difficult to aggregate existing data to draw appropriate conclusions that can inform programs. Further research is necessary to continue highlighting ways for programs, governments, and policymakers to best aid families in low-resource settings in protecting their newborns from major health consequences.
全球每年估计有280万新生儿死亡。新生儿的脆弱性使得及时寻求和获得护理对于新生儿生存及预防长期后遗症至关重要。为了更好地理解社区卫生工作者进行的主动转诊在新生儿寻求护理方面所起的作用，我们综合了关于低收入和中等收入国家中具有预示死亡或严重发病危险体征的新生儿转诊完成率的数据。
2014年5月对以下数据库进行了系统评价：医学期刊数据库 - PubMed、Embase和世界卫生组织数据库。我们还搜索了灰色文献。此外，成立了一个研究小组以识别关于新生儿转诊和完成率的未发表数据。向救助儿童会“拯救新生儿生命”项目支持的研究小组网络及其他相关研究小组进行了询问。
三项撒哈拉以南非洲地区和五项南亚地区的研究报告了社区到医疗机构转诊完成率的数据。这些研究在转诊率、评估的危险体征、新生儿期家访频率以及为促进转诊所采取的措施等因素方面存在差异。新生儿转诊完成率在34%至97%之间，中位数为74%。四项研究报告了早期新生儿期的数据；早期新生儿完成率在46%至97%之间，中位数为70%。不同研究对转诊完成的定义在诸如新生儿被转诊到何处以及何为及时完成等方面存在差异。
现有文献报道了撒哈拉以南非洲地区和南亚地区在积极疾病监测后新生儿转诊完成率的广泛范围。由于研究设计和背景差异很大，解释这些转诊完成率具有挑战性。通常，对于何为转诊和/或转诊完成的定义不明确，这使得难以汇总现有数据以得出可为项目提供参考的适当结论。有必要进一步开展研究，以继续突出项目、政府和政策制定者能够为资源匮乏地区的家庭提供最佳帮助，保护其新生儿免受重大健康后果影响的方式。
