Okai Emmanuel, Fair Frankie, Soltani Hora
Department of Paediatrics, School of Medical Sciences, College of Health and Allied Sciences University of Cape Coast Cape Coast Ghana.
Department of Nursing and Midwifery, College of Health, Wellbeing and Life Sciences Sheffield Hallam University Sheffield UK.
Health Sci Rep. 2024 Mar 7;7(3):e1938. doi: 10.1002/hsr2.1938. eCollection 2024 Mar.
Neonatal deaths contribute significantly to under-5 mortality worldwide with Sub-Saharan Africa (SSA) alone accounting for 43% of global newborn deaths. Significant challenges in the region's health systems evidenced by huge disparities in health facility deliveries and poor planning for preterm births are major contributors to the high neonatal mortality. Many neonates in the region are delivered in suboptimal conditions and require transportation to facilities equipped for specialized care. This review describes neonatal transport across the subregion, focusing on low-cost interventions employed.
We conducted a systematic review of studies on neonatal transport in SSA followed by a narrative synthesis. A search in the databases CINAHL, EMBASE, MEDLINE, Web of Science, African Index Medicus, and Google Scholar was performed from inception to March 2023. Two authors reviewed the full texts of relevant studies to determine eligibility for inclusion which was subsequently cross-checked by a third reviewer using a random 30% overlay. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool.
A total of 20 studies were included in this review involving 11,895 neonates from 10 countries. All studies evaluated the transfer of neonates into referral centers from the peripheries. Most neonates were transferred by public transport ( = 12), mostly in the arms of caregivers with little communication between referring facilities. Studies reporting on ambulance transfers reported pervasive inadequacies in both human resources and transport equipment. No study reported on the use of Kangaroo mother care (KMC) in the transfer process.
The neonatal transport system across the SSA region is poorly planned, poorly resourced, and executed with little communication between facilities. Using cost-effective measures like KMC and improved training of community health workers may be key to improving the outcomes of transported neonates.
新生儿死亡在全球五岁以下儿童死亡率中占比重大，仅撒哈拉以南非洲地区（SSA）就占全球新生儿死亡人数的43%。该地区卫生系统面临重大挑战，卫生设施分娩存在巨大差异以及早产规划不佳就是高新生儿死亡率的主要促成因素。该地区许多新生儿在欠佳的条件下分娩，需要转运至配备专业护理的机构。本综述描述了该次区域的新生儿转运情况，重点关注所采用的低成本干预措施。
我们对撒哈拉以南非洲地区新生儿转运研究进行了系统综述，随后进行叙述性综合分析。从数据库建立至2023年3月，在CINAHL、EMBASE、MEDLINE、科学网、非洲医学索引和谷歌学术中进行了检索。两位作者审查了相关研究的全文，以确定纳入资格，随后由第三位审查者使用30%的随机重叠进行交叉核对。使用混合方法评估工具评估纳入研究的质量。
本综述共纳入20项研究，涉及来自10个国家的11,895名新生儿。所有研究均评估了新生儿从周边地区转运至转诊中心的情况。大多数新生儿通过公共交通工具转运（n = 12），大多由护理人员怀抱，转诊机构之间沟通甚少。报告救护车转运情况的研究表明，人力资源和运输设备普遍不足。没有研究报告在转运过程中使用袋鼠式护理（KMC）。
撒哈拉以南非洲地区的新生儿转运系统规划不善、资源匮乏且执行过程中机构间沟通甚少。采用袋鼠式护理等具有成本效益的措施以及加强社区卫生工作者培训可能是改善转运新生儿结局的关键。
