State of neonatal referral system, referral network pathway, and neonatal transport systems in Nigeria: A Narrative review

Abstract

Nigeria has the highest neonatal mortality rate in Africa. One major contributing factor, which has been grossly unrecognized, is the poor neonatal referral system. The World Health Organisation (WHO) recommends that sick and small newborn infants (SSNIs) should be referred early to higher health care facilities where they can be effectively catered for. Most of the Health Care Facilities (HCFs) where these infants are delivered either have a Level I neonatal units (NNU) or none at all. WHO has classified NNU into Levels I-IIIb, based on the size, availability of specialists, services, and specialized equipment. Following delivery, referral involves just sending (verbally or written) the sick baby to another facility perceived to have the necessary capability to manage that condition at that particular time, without prior communication, stabilisation and appropriate transportation. This may eventually lead to a sick unstable baby being referred multiple times, thereby worsening the clinical condition and prognosis. One major hindrance to successful referral leading to a break in the referral chain is lack of referral network pathway. In other words, there is poor organization and distribution of HCFs with Level IIIIIb NNU. To achieve a successful and effective transportation of infants an ideal transport system is also needed. A comprehensive literature search was conducted to identify relevant peer-reviewed articles on the state of neonatal referral system in Nigeria. The purpose of this review is to bring to the fore the state of neonatal referral system, transport system and referral network pathway in Nigeria.