Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
BMJ Glob Health. 2024 Jan 10;9(1):e012894. doi: 10.1136/bmjgh-2023-012894.
Neonatal mortality remains significant in low-income and middle-income countries (LMICs) with in-hospital mortality rates similar to those following discharge from healthcare facilities. Care continuity interventions have been suggested as a way of reducing postdischarge mortality by better linking care between facilities and communities. This scoping review aims to map and describe interventions used in LMICs to improve care continuity for newborns after discharge and examine assumptions underpinning the design and delivery of continuity.
We searched seven databases (MEDLINE, CINAHL, Scopus, Web of Science, EMBASE, Cochrane library and (Ovid) Global health). Publications with primary data on interventions focused on continuity of care for newborns in LMICs were included. Extracted data included year of publication, study location, study design and type of intervention. Drawing on relevant theoretical frameworks and classifications, we assessed the extent to which interventions adopted participatory methods and how they attempted to establish continuity.
A total of 65 papers were included in this review; 28 core articles with rich descriptions were prioritised for more in-depth analysis. Most articles adopted quantitative designs. Interventions focused on improving continuity and flow of information via education sessions led by community health workers during home visits. Extending previous frameworks, our findings highlight the importance of interpersonal continuity in LMICs where communication and relationships between family members, healthcare workers and members of the wider community play a vital role in creating support systems for postdischarge care. Only a small proportion of studies focused on high-risk babies. Some studies used participatory methods, although often without meaningful engagement in problem definition and intervention implementation.
Efforts to reduce neonatal mortality and morbidity should draw across multiple continuity logics (informational, relational, interpersonal and managerial) to strengthen care after hospital discharge in LMIC settings and further focus on high-risk neonates, as they often have the worst outcomes.
在低收入和中等收入国家（LMICs），新生儿死亡率仍然很高，其院内死亡率与医疗保健机构出院后的死亡率相似。连续性护理干预措施被认为是一种通过更好地在医疗机构和社区之间建立联系来降低出院后死亡率的方法。本范围综述旨在绘制和描述在 LMIC 中用于改善新生儿出院后护理连续性的干预措施，并检查设计和提供连续性的假设。
我们搜索了七个数据库（MEDLINE、CINAHL、Scopus、Web of Science、EMBASE、Cochrane 图书馆和（Ovid）全球健康）。纳入了关于 LMIC 中关注新生儿护理连续性的干预措施的原始数据的出版物。提取的数据包括出版年份、研究地点、研究设计和干预类型。我们借鉴相关理论框架和分类，评估了干预措施采用参与性方法的程度以及它们试图建立连续性的程度。
本综述共纳入 65 篇论文；28 篇具有丰富描述的核心文章被优先进行更深入的分析。大多数文章采用了定量设计。干预措施侧重于通过由社区卫生工作者在家庭访问期间进行的教育课程来提高连续性和信息流。扩展以前的框架，我们的研究结果强调了在 LMIC 中人际连续性的重要性，在这些国家/地区，家庭成员、医疗保健工作者和更广泛社区成员之间的沟通和关系在为出院后护理建立支持系统方面发挥着至关重要的作用。只有一小部分研究关注高危婴儿。一些研究采用了参与性方法，尽管在问题定义和干预实施方面往往没有有意义的参与。
为了降低新生儿死亡率和发病率，应跨越多个连续性逻辑（信息、关系、人际和管理），在 LMIC 环境中加强出院后的护理，并进一步关注高危新生儿，因为他们通常有最糟糕的结果。
