Bridging the gap: Improving neonatal transport in Sub-Saharan Africa

Neonatal transport plays a crucial role in ensuring newborns receive timely and specialised medical care, yet in Sub-Saharan Africa (SSA), transport systems are often unstructured and inadequate. A recent systematic review by Okai, Fair, and Soltani examines existing neonatal transport practices in SSA and evaluates the impact of low-cost interventions on outcomes. The study highlights significant gaps, including the reliance on informal transport methods and poorly equipped ambulances, which put vulnerable neonates at risk. Importantly, despite its proven benefits, no studies reported the use of Kangaroo Mother Care (KMC) in any transport scenarios. The review underscores the urgent need for structured transport systems, better-equipped ambulances, and the integration of cost-effective, evidence-based interventions to improve survival rates. Strengthening communication between referring and receiving facilities is also essential for continuity of care. Addressing these challenges could greatly enhance neonatal health outcomes across the region.

A recent systematic review titled “Neonatal transport practices and effectiveness of the use of low-cost interventions on outcomes of transported neonates in Sub-Saharan Africa: A systematic review and narrative synthesis” by Emmanuel Okai, Frankie Fair, and Hora Soltani, published in Health Science Reports in 2024, delves into the critical issue of neonatal transport in Sub-Saharan Africa (SSA).

Study Objective

The study aimed to assess existing neonatal transport practices within SSA and evaluate the effectiveness of low-cost interventions designed to improve outcomes for transported neonates. This focus is particularly pertinent given that SSA accounts for approximately 43% of global neonatal deaths, with many infants requiring transfer to specialised care facilities after birth.

Methodology

Researchers conducted a comprehensive literature search across multiple databases, including CINAHL, EMBASE, MEDLINE, Web of Science, African Index Medicus, and Google Scholar, covering publications up to March 2023. The inclusion criteria encompassed peer-reviewed studies detailing neonatal transport processes and outcomes within SSA. The review included 20 studies that met the criteria, involving 11,895 neonates from 10 countries.

Key Findings

1. Transport methods: Caregivers often transported neonates via public means, carrying them in their arms with minimal communication between referring and receiving facilities. This lack of structured transport systems poses significant risks to neonatal health during transit.
2. Ambulance services: Studies highlighted widespread deficiencies in both human resources and essential transport equipment when ambulances were used, undermining the quality and safety of neonatal transfers.
3. Low-cost interventions: Notably, none of the reviewed studies reported the implementation of Kangaroo Mother Care (KMC) during transport. KMC, which involves skin-to-skin contact between the mother and infant, is a proven low-cost intervention that can regulate the infant’s temperature and provide physiological stability.

Implications

The findings underscore a critical need for improved planning and resource allocation for neonatal transport in SSA. The prevalent reliance on unregulated public transport and the evident gaps in ambulance services reveal systemic weaknesses that targeted interventions could address.

Implementing cost-effective strategies, such as training community health workers and integrating KMC during transport, could significantly enhance neonatal outcomes. Moreover, establishing structured communication protocols between referring and receiving facilities is essential to ensure continuity of care and preparedness upon arrival.

Conclusion

This review illuminates the pressing challenges in neonatal transport within Sub-Saharan Africa and advocates for the adoption of low-cost, evidence-based interventions to improve survival and health outcomes for transported neonates. By addressing these gaps, healthcare systems in the region can move closer to achieving equitable and effective neonatal care.

Paper available at: Health Science Reports

Full list of authors: Emmanuel Okai, Frankie Fair, Hora Soltani

DOI: 10.1002/hsr2.1938