The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006]

Rudge, Marilza; Maestá, Izildinha; Moura, Paula MSS; Rudge, Cibele Vieira Cunha; Morceli, Glilciane; Costa, Roberto AA; Abbade, Joélcio Francisco; Peraçoli, José Carlos; Calderon, Iracema de Mattos Paranhos

doi:10.1186/1742-4755-8-34

Cited by 8 publications

(15 citation statements)

References 21 publications

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“…Only four papers in our review evaluated interventions designed to improve surgical referral and care systems in the participating countries. Three studies focused on inter-hospital coordination mechanisms [6,15,16], while the fourth one examined a surgical skills development programme [31]. A description of each study is provided in the following section.…”

Section: Resultsmentioning

confidence: 99%

“…Despite growing attention to hospital surgical capacity in LMICs [8], referral systems and the interface between the different level hospitals have been under-researched [4,11,15]. If equitable access to essential surgical services is to be achieved, sound evidence is needed to ensure efficient patient care pathways [4,16]. This review investigates current knowledge regarding surgical referral systems in LMICs in order to: i) identify the main obstacles to their functioning effectively; and ii) identify proposed and tested solutions, and the available evidence of their effectiveness in addressing these gaps.…”

Section: Introductionmentioning

confidence: 99%

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Surgical referral systems in low- and middle-income countries: A review of the evidence

2019

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BackgroundReferral networks are critical in the timely delivery of surgical care, particularly for populations residing in rural areas who have limited access to specialist services. However, in low- and middle-income countries (LMICs) referral networks are often undermined by systemic inefficiencies. If equitable access to essential surgical services is to be achieved, sound evidence is needed to ensure efficient patient care pathways. The aim of this scoping review was to investigate current knowledge regarding inter-hospital surgical referral systems in LMICs to identify the main obstacles to their functioning and to critically assess proposed solutions.MethodsMEDLINE, EMBASE and Global Health databases and grey literature were systematically searched to identify relevant studies. The search generated 2261 unique records, of which 14 studies were selected for inclusion in the review. The narrative synthesis of retrieved data is based on a conceptual framework developed though a thematic analysis approach.ResultsMultiple shortages in surgical infrastructure, equipment and personnel, as well as gaps in surgical and decision-making skills of clinicians at sending hospitals, act as obstacles to safe and appropriate referrals. Comprehensive protocols for surgical referrals are lacking in most LMICs and established patient pathways, when in place, are not correctly followed. Interventions to improve coordination and communication between different level facilities may enhance efficiency of referral pathways. Strengthening capacity of referring hospitals to manage more surgical conditions locally could improve outcomes, decrease the need for referral and reduce the burden on tertiary facilities.DiscussionThe field of surgical referrals is still an uncharted territory and the limited empirical evidence available is of low quality. Developing strategies for assessing functionality and effectiveness of referral systems in surgery is essential to improve access, coverage and quality of services in resource-limited settings, as well as overall health systems performance.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical referral systems in low- and middle-income countries: A review of the evidence

2019

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“…Many developing countries paid special attention to the organisation of the referral system to improve maternal and child healh [Rudge et al, 2011]. Likewise, the National Perinatality Program of Mali was conceived in 1994 and organised the referral system to improve the environment of perinatal care.…”

Section: Referral System and Cesarean Deliverymentioning

confidence: 99%

Determining Factors of Cesarean Delivery Trends in Developing Countries: Lessons from Point G National Hospital (Bamako - Mali)

Teguété¹,

Traoré²,

Sissoko³

et al. 2012

Cesarean Delivery

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“…Na falta da equipe mínima necessária para o atendimento obstétrico, a mulher deveria ser encaminhada, principalmente se a cesárea é eletiva. Rudge et al 15 realizaram um estudo analisando os resultados do sistema de referência obstétrica em uma região de São Paulo. Entre os principais resultados desta estratégia, apontam: a diminuição da taxa de cesárea de 46,5 para 23,4% no nível II, de baixo risco, do hospital, e a manutenção da taxa do nível III, considerado de alto risco.…”

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A morte materna no Brasil: razão e sensibilidade

Serruya¹

2012

Rev. Bras. Ginecol. Obstet.

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As estimativas globais sobre o declínio da mortalidade materna revelaram que os resultados atingidos não serão suficientes para alcançar, na maioria dos países, as Metas de Desenvolvimento do Milênio, de reduzir em 75% a razão da mortalidade materna em 15 anos 1,2 . Em 2010, havia sido alcançada a redução de 47%, tomando como ano a razão de 1990, o que significa em números absolutos que aproximadamente 287.000 mortes maternas ocorreram em todo o mundo. Duas regiões se destacam: a África Subsaariana (56%) e o Sul da Ásia (29%), que respondem por 85% do número absoluto total (245.000 mortes maternas) em 2010. Apenas dois países são responsáveis por um terço das mortes maternas globais: a Índia, com 19% (56.000) e a Nigéria, com 14% (40.000). A razão de morte materna em 2010 foi de 210 mortes maternas por 100.000 nascidos vivos, ou seja, quase a metade das 400 mortes maternas por 100.000 nascidos vivos em 1990. Nesta mesma publicação, devido ao método e ao fator de correção empregados, a razão para a América Latina e o Caribe é de 80, e a do Brasil é de 56, dentro de um intervalo com um limite de confiança entre 36 e 85 com número absoluto de mortes de 1998 3 .Controvérsias metodológicas e números absolutos a parte, todos concordam que a redução foi importante, mas insuficiente, e que será necessário aumentar a velocidade de declínio no tempo remanescente para alcançar a meta estipulada. Em setembro de 2010, o Secretário Geral da ONU lançou a "Estratégia Global de Saúde de Mulheres e Crianças", buscando mobilizar apoio por parte dos governos, organizações da sociedade civil e outros parceiros em resposta à necessidade de acelerar esforços para salvar a vida e melhorar a saúde das mulheres e recém-nascidos 4 . As Nações Unidas reconhecem que existe uma lacuna entre o investimento necessário e o que está atualmente previsto para a saúde das mulheres e crianças, e que para produzir mudanças previstas é necessário incrementar os recursos financeiros em cerca de U$40 bilhões ao longo dos próximos cinco anos 5

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The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006]

Cited by 8 publications

References 21 publications

Surgical referral systems in low- and middle-income countries: A review of the evidence

Surgical referral systems in low- and middle-income countries: A review of the evidence

Determining Factors of Cesarean Delivery Trends in Developing Countries: Lessons from Point G National Hospital (Bamako - Mali)

A morte materna no Brasil: razão e sensibilidade

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