Table 1 Description of included studies
From: A systematic review of community-to-facility neonatal referral completion rates in Africa and Asia
Country and start year of study, official study name | Setting (years) | Purpose of study | Active surveillance | % of enrolled population who received home visit, at what timing | Referral facilitation | Referral from whom to where | Timing definition of referral completion | |
|---|---|---|---|---|---|---|---|---|
Asia | Bangladesh 2003 | Rural Bangladesh (2003–2005) | RCT of home-based management of newborn infections by community health workers | Days 1, 3, 7, but if sick, daily visits made to complete antibiotic therapy and stress completion | Babies receiving at least one postnatal home visit increased from 46 to 79 % from beginning to end of study, timing unclear | Follow-up visit within 24 h for those who did not complete referral | Study staff (CHW) to government subdistrict hospitals, distinguished between completion to qualified vs. unqualified source, 38 % of those who sought care from qualified provider sought care from private sector | No timing indicated |
Projanhmo 1 [14] | ||||||||
Bangladesh 2004 | Rural Bangladesh (2004–2006) | Study on improvement of household careseeking behavior through community health worker engagement | Days 1, 3, 6, 9, 28 | 73 % were assessed at least once, 54 % within first two days of birth | Referral slips, birth and neonatal care preparedness cards, referral tracking form, free care if coming to referral facility, system of emergency transport, training of TBAs | Study staff (CHW) to Kumudini Hospital, home-based care offered if refused | No timing indicated | |
Nepal 2002 | Rural Nepal (2002–2005) | RCTs of chlorhexidine application on newborn skin and/or umbilical cord for reduction of neonatal infections and associated mortality | Days 1, 2, 3, 4, 6, 8, 10, 12, 14, 21, 28 | ~62 % receiving first visit within 24 h, 96 % receiving first visit within 3 days | No facilitation | Study staff (CHW-level) to nearest facility | Care sought within 28 days of life | |
Nepal 2005 | Rural Nepal (2005–2007) | Study on offering home-based care and referral for possible severe bacterial infection | Active (within 24 h of delivery), then passive up to 2 months. Graduation visit made at 2 months. | 63 % within seven days of birth, 97 % for two-month follow-up visit | No facilitation | Female Community Health Volunteers to Facility Based – CHWs | Care sought within 28 days of life | |
Morang Innovative Neonatal Intervention (MINI)a [11] | ||||||||
Pakistan 2011 | Rural Pakistan | Study on identification of etiologies of newborn sepsis | Days 2, 6, 13, 20, 27, 34, 41, 48, 59 | 90Â % of enrolled newborns were followed at scheduled visits | Provided transport for referral to health facility. Follow-up visit within 24Â h for those who did not complete referral | Study staff (CHW) to facility, study physicians at facility to tertiary facility | No timing indicated | |
Aetiology of Neonatal Infection in South Asia (ANISA) (unpublished)a | ||||||||
Africa | Ghana 2008 | Rural Ghana (2008–2009) | RCT on improving neonatal health by training existing community-based surveillance volunteers to identify and conduct ANC/PNC visits | Days 1, 3, 7 | 63 % with at least one postnatal visit, 53 % in representative subsample had first visit on day of delivery or day after | Training and incentives for volunteers, materials and supervision for hospital newborn care strengthening and sensitization activities, referral card, counselled on keeping baby warm and frequent bf, dialoged and problem-solved around barriers, 24-h follow-up to check compliance, counselling at 2nd and 3rd PNC visits on five illness signs (stopped or poor feeding, too hot or too cold, difficult or fast breathing, jaundice, less active/lethargy) | Community-based surveillance volunteers to hospital or clinic, urban residents tended to comply to hospitals/clinics, rural residents to health center | No timing indicated |
South Africa 2008 | Urban South Africa (2008–2011) | RCT on home visit package to improve essential maternal/newborn care and PMTCT | First 24–48 h, day 3/4, day 10–14, within 3–4 weeks, after 6 weeks. | 59 % received the first post-natal visit and of these 73 % within 48 h after discharge from hospital following delivery | Training and incentives referral slips, Partner Defined Quality approach to improve facility quality | Pre-existing CHW cadre to local PHC clinic | Care sought within 28 days of life | |
Good Starta [9] | ||||||||
Uganda 2009 | Rural Uganda (2009–2011) | RCT on integrated maternal-newborn care package linking communities to facilities | Days 1, 3, 7, then quarterly surveys to follow up on referred newborns | N/A | Facility improvement, provision of referral forms, follow-up visit within 24 h | Pre-existing CHW cadre to hospital or health center grades II-IV (II and III are PHC clinics) | Within 24 h of referral | |
Uganda Newborn Survival Study (UNEST) [10]a | ||||||||