Abstract

Background: The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) currently have no benchmarks or 'norms' for scaling up small and sick newborn (SSN) service delivery in health facilities in low- and middle-income countries (LMICs). Our objective was to understand which systematic reviews had addressed the following norms in the last five years: number of SSN beds per live births in a district or similar administrative unit (admission beds); space requirements for SSN units, including mother-infant dyads (space); health workforce ratios in SSN units (workforce); and travel time to health facilities with SSN units (travel time). Methods: We searched for systematic reviews of admission beds, space, workforce and travel time norms for SSN under 28 days of age and their mothers in all health facilities and countries, regardless of infant gestational age and birth weight, that had been published in the previous five years (2018-23). For beds, space, and workforce norms, we searched for reviews of prevalence, incidence, mean and median estimates. For the travel time norm, we searched for reviews of estimates of effect, i.e. dichotomous (e.g. relative risks) or continuous measures (e.g. mean differences). Results: We identified 9110 records and included eight systematic reviews published in the last five years: two related to space, five to workforce, and one to travel time norms. We found no reviews for admission bed norms. Two reviews included high income countries only, while three included tertiary neonatal intensive care units only. The reviews provided estimates of mean space requirements in SSN units, health workforce ratios of doctors and nurses, and optimal travel time to health facilities for SSN. Seven of the eight reviews had high risk of bias. Conclusions: Despite the high burden of SSN in LMICs and the need to scale up hospital care, there have been few systematic reviews into this topic, and rigorous syntheses of evidence are lacking. The WHO and the UNICEF have now commissioned four systematic reviews. The next steps will be to analyse real-world country-level data and develop implementation guidance. Registration: PROSPERO: CRD42023417847, CRD42023451302, CRD42023478512, CRD42023453644.

Document Type

Journal Article

Date of Publication

11-21-2025

Volume

15

PubMed ID

41264546

Publication Title

Journal of Global Health

Publisher

International Society of Global Health

School

Kurongkurl Katitjin

Funders

Bill and Melinda Gates Foundation (050339)

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Comments

Strobel, N. A., Whisson, G., Swe, D., Budrikis, A., & Edmond, K. M. (2025). Norms for scaling up small and sick newborn care: an overview of reviews. Journal of Global Health, 15. https://doi.org/10.7189/jogh.15.04290

First Page

04290

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Link to publisher version (DOI)

10.7189/jogh.15.04290