Population, Policy Practice Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
Aceso Global Health Consultants Pte Limited, Singapore, Singapore.
Int J Health Plann Manage. 2023 Sep;38(5):1360-1376. doi: 10.1002/hpm.3655. Epub 2023 May 24.
During humanitarian emergencies, women and children are particularly vulnerable to health complications and neonatal mortality rates have been shown to rise. Additionally, health cluster partners face challenges in coordinating referrals, both between communities and camps to health facilities and across different levels of health facilities. The purpose of this review was to identify the primary referral needs of neonates during humanitarian emergencies, current gaps and barriers, and effective mechanisms for overcoming these barriers.
A systematic review was performed using four electronic databases (CINAHL, EMBASE, Medline, and Scopus) between June and August 2019 (PROSPERO registration number CRD42019127705). Title, abstract, and full text screening were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The target population was neonates born during humanitarian emergencies. Studies from high-income countries and prior to 1991 were excluded. The STROBE checklist was used to assess for risk of bias.
A total of 11 articles were included in the analysis; these were mainly cross-sectional, field-based studies. The primary needs identified were referrals from homes to health facilities before and during labour, and inter-facility referrals after labour to more specialised services. Some of the main barriers included a lack of roads and infrastructure for transport, staff shortages-especially among more specialised services, and a lack of knowledge among patients for self-referral. Mechanisms for addressing these needs and gaps included providing training for community healthcare workers (CHWs) or traditional birth attendants to identify and address antenatal and post-natal complications; education programmes for pregnant women during the antenatal period; and establishing ambulance services in partnership with local Non-Governmental Organizations.
This review benefited from a strong consensus among selected studies but was limited in the quality of data and types of data that were reported. Based on the above findings, the following recommendations were compiled: Focus on local capacity-building programmes to address programmes acutely. Recruit CHWs to raise awareness of neonatal complications among pregnant women. Upskill CHWs to provide timely, appropriate and quality care during humanitarian emergencies.
在人道主义紧急情况下，妇女和儿童特别容易受到健康并发症的影响，新生儿死亡率已有所上升。此外，卫生群组合作伙伴在协调转介方面面临挑战，无论是在社区和营地之间向卫生机构转介，还是在不同级别的卫生机构之间转介。本综述的目的是确定人道主义紧急情况下新生儿的主要转介需求、当前的差距和障碍，以及克服这些障碍的有效机制。
使用四个电子数据库（CINAHL、EMBASE、Medline 和 Scopus）在 2019 年 6 月至 8 月期间进行了系统评价（PROSPERO 注册号 CRD42019127705）。采用系统评价和荟萃分析的首选报告项目进行标题、摘要和全文筛选。目标人群是在人道主义紧急情况下出生的新生儿。排除高收入国家和 1991 年之前的研究。采用 STROBE 清单评估偏倚风险。
共有 11 篇文章纳入分析，主要为横断面、实地研究。确定的主要需求是在分娩前和分娩期间从家中向卫生机构转介，以及分娩后向更专门的服务机构进行机构间转介。一些主要障碍包括缺乏交通道路和基础设施、人员短缺——特别是在更专门的服务机构中，以及患者缺乏自我转介的知识。解决这些需求和差距的机制包括为社区卫生工作者（CHWs）或传统助产妇提供培训，以识别和处理产前和产后并发症；在产前期间为孕妇提供教育方案；并与当地非政府组织合作建立救护车服务。
本综述受益于选定研究之间的强烈共识，但受到报告的数据质量和数据类型的限制。基于上述发现，提出以下建议：注重当地能力建设方案，以应对紧急情况。招聘 CHWs 提高孕妇对新生儿并发症的认识。提高 CHWs 的技能，以便在人道主义紧急情况下提供及时、适当和优质的护理。
