The Effectiveness of Emergency Obstetric Referral Interventions in Developing Country Settings: A Systematic Review

The Effectiveness of Emergency Obstetric Referral Interventions in Developing Country Settings: A Systematic Review

Pregnancy complications can be unpredictable and many women in developing countries cannot access health facilities where life-saving care is available. ? It should be possible to reduce maternal deaths (and the deaths of babies during pregnancy, childbirth, and early life) in developing countries by ensuring that pregnant women are referred to emergency obstetric services quickly when the need arises. Unfortunately, in such countries referral to emergency obstetric care is beset with problems such as difficult geographical terrain, transport costs, lack of vehicles, and suboptimal location and distribution of health care facilities.

In this systematic review, the researchers assess the effectiveness of interventions designed to reduce the ‘‘phase II delay’’ in referral to emergency obstetric care in developing countries — the time it takes a woman to reach an appropriate health care facility once a problem has been recognised and the decision has been taken to seek care.

The findings suggest that community mobilisation interventions may reduce neonatal mortality and that maternity waiting rooms may reduce stillbirths. Importantly, they also highlight how referral interventions can have unexpected adverse effects. However, because the studies included in this systematic review included multiple interventions designed to reduce delays at several stages of the referral process, it is not possible to disentangle the contribution of each component of the intervention. Moreover, it is impossible at present to determine why (or even if) any of the interventions reduced maternal mortality. Thus, the researchers conclude, improved monitoring of interventions and better evaluation of outcomes is essential to inform the implementation of effective referral interventions, and more studies are needed to improve understanding of how referral interventions work.

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