Exploring barriers and facilitators to surgical referrals for neonates with congenital anomalies

Abstract

Advancements in medicine have resulted in decreased neonatal mortality and morbidity associated with congenital anomalies (CA). Unfortunately, the advantages of these developments have been confined to high-income countries (HICs), demonstrated by the comparatively high incidence of congenital anomalies in low and low-middle-income countries (LLMICs). Evidence suggests that neonates in LLMICs encounter considerably more barriers to care than those in HICs due to a malfunctioning referral system and poorly implemented health policies that hinder the timely provision of care. As many CA are now accepted as surgically treatable, the purpose of this study was to understand what inhibits the success of a neonate from obtaining surgery in LLMICs and how that could be improved. Seven databases were searched in this systematic review to identify articles on neonates with surgically treatable CA. A total of 370 studies were identified for screening; 16 were included in the final analysis. Studies were screened and selected individually by two researchers based on the research question, and all disagreements were resolved jointly. Studies were reviewed for factors affecting the delivery of surgical treatment and were then coded as a barrier or a facilitator. Barriers to care were identified in every study, and suggested facilitators were offered by the authors, but these facilitators were not tested in the studies. This study contributes to the literature by providing additional detail on what is known about the surgical referral system in LLMICs. The study findings will inform policymakers and local governments of the realities faced by neonates and their caregivers while navigating through the surgical referral system and establish the need for alternate policy implementation strategies.