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Qualitative study on maternal referrals in rural Tanzania: Decision making and acceptance of referral advice
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- & mödrahälsovård/Essén)
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health. (Internationell kvinno- & mödrahälsovård/Essén)
(Internationell kvinno- & mödrahälsovård/Essén)
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2008 (English)In: African Journal of Reproductive Health, ISSN 1118-4841, Vol. 12, no 2, 120-131 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe perceptions of maternal referrals in a rural district in Tanzania. Focus groupdiscussions (FGDs) with health workers and community members, stratified by age and gender, were conducted.The FGDs revealed that husbands and relatives are the decision makers in maternal referrals, whereas the womenhad limited influence, especially on emergency referrals. The process in deciding to seek referral care is envisagedwithin community perception of seriousness of the condition, difficulty to access and cost involved in transport,living expenses at the hospital, and perceived quality of care at facility level. The hospitals were seen as providingacceptable quality of care, whereas, the health centres had lower quality than expected.

To improve maternal referral compliance and reduce perinatal and maternal morbidity and mortality,communityviews of existing referral guidelines, poverty reduction, women’s empowerment and male involvement inmaternal care are necessary.

Place, publisher, year, edition, pages
2008. Vol. 12, no 2, 120-131 p.
Keyword
maternal referrals, decision making, rural, Tanzania, FGD
Research subject
Identifiers
URN: urn:nbn:se:uu:diva-87188OAI: oai:DiVA.org:uu-87188DiVA: diva2:24320
Available from: 2008-11-27 Created: 2008-09-22 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Quality Assessment and Monitoring of Maternal Referrals in Rural Tanzania
Open this publication in new window or tab >>Quality Assessment and Monitoring of Maternal Referrals in Rural Tanzania
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

An efficient referral system is essential in providing access to emergency obstetric care at higher levels of care by supporting antenatal and delivery services in the primary level of care facilities (PLCF). The aim of this thesis was to assess community and health service factors affecting the quality of maternal referrals in rural Tanzania.

Ten focus group discussions (FGDs) with health workers and community members were conducted to describe their perceptions on maternal referrals. Women (n=1118) were interviewed to determine awareness of obstetric danger signs and associated factors. Compliance with referral advice was analysed for 1538 women referred from PLCF. Counselling on danger signs and adherence to referral criteria was observed in 438 antenatal consultations.

FGDs indicated that women had limited influence, especially on emergency referrals. The process of deciding to seek referral care considered the perception of seriousness and past experience of referral, access to transport, and the cost involved. Women had low awareness of danger signs of obstetric complications: higher years of schooling increased the likelihood of being aware of danger signs. Demographic risks accounted for 70% of referred women but less than half complied with the advice. Compliance was higher for historical obstetric risks, prenatal, natal, and postnatal complications groups. Few women were counselled on pregnancy danger signs and a significant number with ≥5 pregnancies and primigravidae <20 years were not informed of the risk factors.

This thesis demonstrated a need for reviewing referral guidelines and an increase in supportive supervision for health workers counselling on obstetric danger signs to enhance acceptance of referrals advices. Women’s education should be given priority for increasing participation in decisions and becoming more aware of danger signs. Costs involved in maternal referrals can be relieved by improving family income, infrastructure, and alleviating the cost of referral through mobilising community transport and financial schemes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 62 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 552
Keyword
Quality, maternal referral, counselling, monitoring, rural, Tanzania
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
International Health
Identifiers
urn:nbn:se:uu:diva-122166 (URN)978-91-554-7784-4 (ISBN)
Public defence
2010-05-20, Rosénsalen, University Hospital, entrance 95/96 nb, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2010-04-29 Created: 2010-04-06 Last updated: 2010-04-29Bibliographically approved

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African Journal of Reproductive Health

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