Community-level detection and referral mechanisms for critical illness in sub-Saharan Africa: a scoping review protocol

Objective: Our objective is to map and characterise existing evidence on community and pre-hospital strategies to detect and refer patients with critical illness in sub-Saharan Africa. Introduction: Critical illness is a major cause of mortality in sub-Saharan Africa. Delays in recognition and presentation to hospital care are common and associated with increased mortality. Community-level approaches to detect critical illness and facilitate referral may improve timely access to care. The extent and characteristics of this evidence have not been previously evaluated. We will identify existing literature to describe and compare strategies between populations, settings, and contexts; identify evidence gaps; and inform development of interventions to strengthen pathways to emergency and inpatient care. Inclusion criteria: We will include evidence relating to acute and critical illness in sub-Saharan Africa. Eligible articles will describe community-level detection, triage, recognition, screening, and referral. We will include studies conducted in community, primary healthcare, and pre-hospital settings. Articles focused exclusively on chronic disease management, chronic disease pathways, hospital-based care pathways, including outpatient clinics attached to secondary or tertiary hospitals, or settings outside sub-Saharan Africa will be excluded. Methods: Our review will follow JBI methodology for scoping reviews. The search strategy will be conducted in MEDLINE, Embase, Global Health, Global Index Medicus, SciELO, with no language or date restrictions. Two reviewers will independently screen studies and extract data. Results will be presented using tables, figures, and narrative synthesis to describe detection mechanisms and referral pathways.