Skip to main content

01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

A systematic review of community-to-facility neonatal referral completion rates in Africa and Asia

BMC Public Health > Ausgabe 1/2015
Naoko Kozuki, Tanya Guenther, Lara Vaz, Allisyn Moran, Sajid B. Soofi, Christine Nalwadda Kayemba, Stefan S. Peterson, Zulfiqar A. Bhutta, Sudhir Khanal, James M. Tielsch, Tanya Doherty, Duduzile Nsibande, Joy E. Lawn, Stephen Wall
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-015-2330-0) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

NK drafted the manuscript, designed the study, and conducted the literature review. TG, LV, AM, JEL, and SW helped design the study, provided extensive feedback on drafts, and approved the final manuscript. SBS, CN, and SK conducted additional analysis for their respective studies, reviewed drafts, and approved the final manuscript. SSP and ZAB reviewed drafts and provided data and approved the final manuscript. JMT, TD, and DN reviewed drafts and approved the final manuscript. All authors read and approved the final manuscript.

Authors’ information

Not applicable.



An estimated 2.8 million neonatal deaths occur annually worldwide. The vulnerability of newborns makes the timeliness of seeking and receiving care critical for neonatal survival and prevention of long-term sequelae. To better understand the role active referrals by community health workers play in neonatal careseeking, we synthesize data on referral completion rates for neonates with danger signs predictive of mortality or major morbidity in low- and middle-income countries.


A systematic review was conducted in May 2014 of the following databases: Medline-PubMed, Embase, and WHO databases. We also searched grey literature. In addition, an investigator group was established to identify unpublished data on newborn referral and completion rates. Inquiries were made to the network of research groups supported by Save the Children’s Saving Newborn Lives project and other relevant research groups.


Three Sub-Saharan African and five South Asian studies reported data on community-to-facility referral completion rates. The studies varied on factors such as referral rates, the assessed danger signs, frequency of home visits in the neonatal period, and what was done to facilitate referrals. Neonatal referral completion rates ranged from 34 to 97 %, with the median rate of 74 %. Four studies reported data on the early neonatal period; early neonatal completion rates ranged from 46 to 97 %, with a median of 70 %. The definition of referral completion differed by studies, in aspects such as where the newborns were referred to and what was considered timely completion.


Existing literature reports a wide range of neonatal referral completion rates in Sub-Saharan Africa and South Asia following active illness surveillance. Interpreting these referral completion rates is challenging due to the great variation in study design and context. Often, what qualifies as referral and/or referral completion is poorly defined, which makes it difficult to aggregate existing data to draw appropriate conclusions that can inform programs. Further research is necessary to continue highlighting ways for programs, governments, and policymakers to best aid families in low-resource settings in protecting their newborns from major health consequences.
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2015

BMC Public Health 1/2015 Zur Ausgabe