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Maternal referral system in Rufiji rural district in Tanzania
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (International maternal and reproductive health)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (International maternal and reproductive health)
Department of Community Health, Muhimbili University of Health and Allied Sciences. (International maternal and reproductive health)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (International maternal and reproductive health)
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(English)Manuscript (preprint) (Other (popular science, discussion, etc.))
Abstract [en]

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.

Keyword [en]
Maternal referral, obstetric complication, high risk pregnancies, rural, Tanzania
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
International Health
Identifiers
URN: urn:nbn:se:uu:diva-122148OAI: oai:DiVA.org:uu-122148DiVA: diva2:309566
Available from: 2010-04-07 Created: 2010-04-06 Last updated: 2010-04-07
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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