Maternal referral system in Rufiji rural district in Tanzania
(English)Manuscript (preprint) (Other (popular science, discussion, etc.))
Objective: To evaluate the effectiveness of the maternal referral system through determining proportion of women reaching the hospitals after referral advice, appropriateness of the referral indications, reasons for non-compliance and to find out if compliance to referrals makes a difference in the perinatal outcome.
Design: A prospective cohort study.
Setting: Rufiji rural district, Tanzania.
Study participants: One thousand five hundred and thirty eight women referred from 18 primary level of care facilities during the 13 months.
Data collection: Referred women were identified at hospitals. Those not reaching the hospitals were traced and interviewed.
Main outcome measures: Compliance to referral advice, reasons for non-compliance, appropriateness of referral indication, and perinatal outcome.
Results: Out of 1538 women referred 70% were referred for demographic risks, 12% for historical obstetric risks, 12% for prenatal complications and 5.5% for natal and immediate postnatal complications. Five or more pregnancies as well as age <20 years were the most common referral indications. The compliance rate was 37% for women referred due to demographic risks and more than 50% among women referred in the other groups. Among women who did not comply with referral advice, almost half of them mentioned financial constraints as the major factor. Lack of compliance with the referral did not significantly increase the risk for a perinatal death.
Conclusion: Majority of the maternal referrals were due to demographic risks, where few women complied. To improve compliance to maternal referrals there is need to review referral indications and strengthen counselling on birth preparedness and complication readiness.
Maternal referral, obstetric complication, high risk pregnancies, rural, Tanzania
Obstetrics, Gynecology and Reproductive Medicine
Research subject International Health
IdentifiersURN: urn:nbn:se:uu:diva-122148OAI: oai:DiVA.org:uu-122148DiVA: diva2:309566