Care Seeking for Neonatal Illness in Low- and Middle-Income Countries: A Systematic Review

BackgroundDespite recent achievements to reduce child mortality, neonatal deaths continue to remain high, accounting for 41% of all deaths in children under five years of age worldwide, of which over 90% occur in low- and middle-income countries (LMICs). Infections are a leading cause of death and limitations in care seeking for ill neonates contribute to high mortality rates. As estimates for care-seeking behaviors in LMICs have not been studied, this review describes care seeking for neonatal illnesses in LMICs, with particular attention to type of care sought. Methods and FindingsWe conducted a systematic literature review of studies that reported the proportion of caregivers that sought care for ill or suspected ill neonates in LMICs. The initial search yielded 784 studies, of which 22 studies described relevant data from community household surveys, facility-based surveys, and intervention trials. The majority of studies were from South Asia (n = 17/22), set in rural areas (n = 17/22), and published within the last 4 years (n = 18/22). Of the 9,098 neonates who were ill or suspected to be ill, 4,320 caregivers sought some type of care, including care from a health facility (n = 370) or provider (n = 1,813). Care seeking ranged between 10% and 100% among caregivers with a median of 59%. Care seeking from a health care provider yielded a similar range and median, while care seeking at a health care facility ranged between 1% and 100%, with a median of 20%. Care-seeking estimates were limited by the few studies conducted in urban settings and regions other than South Asia. There was a lack of consistency regarding illness, care-seeking, and care provider definitions. ConclusionsThere is a paucity of data regarding newborn care-seeking behaviors; in South Asia, care seeking is low for newborn illness, especially in terms of care sought from health care facilities and medically trained providers. There is a need for representative data to describe care-seeking patterns in different geographic regions and better understand mechanisms to enhance care seeking during this vulnerable time period. Please see later in the article for the Editors' Summary研究背景 尽管近期在降低儿童死亡率方面已取得诸多进展，但新生儿死亡人数仍居高不下，占全球5岁以下儿童死亡总数的41%，其中90%以上发生在低收入和中等收入国家（low- and middle-income countries, LMICs）。感染是新生儿死亡的主要诱因，而患病新生儿的就医护理获取受限进一步推高了死亡率。由于目前尚未针对低收入和中等收入国家的新生儿就医行为开展相关评估，本综述旨在阐述该类国家中新生儿疾病的就医情况，并重点关注所寻求的护理类型。 方法与结果 我们针对低收入和中等收入国家中患病或疑似患病新生儿的看护者就医比例相关研究开展了系统文献综述。初步检索共得到784项研究，其中22项研究提供了来自社区家庭调查、基于医疗机构的调查以及干预试验的相关数据。大部分研究（n=17/22）来自南亚，开展于农村地区（n=17/22），且均为近4年内发表的成果（n=18/22）。在9098名患病或疑似患病的新生儿中，共有4320名看护者为患儿寻求了各类护理服务，其中包括医疗机构护理（n=370）或医疗服务提供者护理（n=1813）。看护者的就医率介于10%至100%之间，中位数为59%。从医疗服务提供者处获得护理的比例区间与中位数相近，而在医疗机构就诊的比例则介于1%至100%之间，中位数为20%。由于仅少数研究在城市环境及南亚以外地区开展，相关就医率评估存在局限性。此外，疾病定义、就医行为定义以及医疗服务提供者定义均缺乏一致性。 结论 目前关于新生儿就医行为的数据较为匮乏；在南亚地区，新生儿疾病的就医率偏低，尤其是在寻求医疗机构护理以及接受医学培训的医疗服务提供者服务方面。我们需要获取具有代表性的数据，以阐明不同地理区域的就医模式，并进一步明确在这一脆弱时期提升新生儿就医行为的内在机制。如需查看编辑总结，请参见本文后续章节。