Teklu Alula M, Litch James A, Tesfahun Alemu, Wolka Eskinder, Tuamay Berhe Dessalegn, Gidey Hagos, Cheru Wondimye Ashenafi, Senturia Kirsten, Gezahegn Wendemaghen
St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), 19009 33rd Avenue W, Suite 200, Lynnwood, Seattle, WA, 98036, USA.
BMC Pediatr. 2020 Aug 29;20(1):409. doi: 10.1186/s12887-020-02311-6.
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.
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.
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.
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.
一个响应迅速且运转良好的新生儿转诊系统是儿童连续医疗保健的基石；然而，卫生系统和与服务对象相关的障碍对转诊系统产生了负面影响。由于新生儿转诊流程复杂且具有多面性，关于新生儿转诊系统的研究一直有限。本研究的目的是评估埃塞俄比亚三个不同地区基层医疗单位中早产、低出生体重和患病新生儿转诊系统有效运作的障碍。
在选定的医疗机构中，对早产、低出生体重和患病新生儿的母亲进行访谈，对机构负责人进行访谈，并与医疗服务提供者进行焦点小组讨论，从而进行定性评估。使用迭代开发的编码手册对数据进行编码，并通过主题内容分析进行综合。
在新生儿转诊系统中发现了三个方面的差距和障碍：交通与转诊沟通；新生儿转诊协议的可用性和遵守情况；以及家庭对新生儿转诊的不情愿或拒绝。具体而言，城乡环境中最常提到的障碍包括救护车短缺、提供者之间以及机构之间转诊和回诊沟通不协调、新生儿转诊协议不可用或未得到遵守、家庭对未知情况的恐惧、尽管转诊仍预期婴儿死亡以及与转诊相关的患者费用。
由于埃塞俄比亚联邦卫生部专注于避免儿童早期死亡，迫切需要政府对新生儿转诊系统进行投资，并规范转诊和回诊沟通。一种补充方法是通过改善卫生系统较低层级的服务范围和质量，以提供基本和高级新生儿护理，从而减轻上级医疗机构的转诊负担。
