Patterns, travel to care and factors influencing obstetric referral

Evidence from Nigeria's most urbanised state

Datos Bibliográficos

ID4595653
AutoresAduragbemi Banke-Thomas (0000-0002-4449-0131, London School of Economics and Political Science, autor de correspondencia), Cephas Avoka (0000-0002-7298-3670, Ghana College of Physicians and Surgeons), Abimbola Olaniran (0000-0001-5491-8536, London School of Hygiene & Tropical Medicine), Modasola Balogun (0000-0001-8147-2111, University of Lagos), Owen Wright (0000-0002-5776-498X, Lagos State University), Olabode Ekerin (0000-0002-1799-2988, Obafemi Awolowo University), Lenka Beňová (0000-0001-8595-365X, Instituut voor Tropische Geneeskunde)
Año2021
Volumen291
Páginas114492
Fecha de publicación2021-12-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaSocial Science & Medicine (JOURNAL)
Identificadores de la revistaISSN: 0277-9536 • E-ISSN: 1873-5347
EditorialElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2021.114492
PMID34662765
OpenAlexW3206507353
IdiomaEN
Citas recibidas5
Referencias citadas43

The criticality of referral makes it imperative to study its patterns and factors influencing it at a health systems level. This study of referral in Lagos, Nigeria is based on health records of 4181 pregnant women who presented with obstetric emergencies at one of the 24 comprehensive emergency obstetric care (EmOC) facilities in the state between November 2018 and October 2019 complemented with distance and time data extracted from Google Maps. Univariate, bivariate, and multivariate analyses were conducted. About a quarter of pregnant women who presented with obstetric emergencies were referred. Most referrals were from primary health centres (41.9 %), private (23.5 %) and public (16.2 %) hospitals. Apart from the expected low-level to high-level referral pattern, there were other patterns observed including non-formal, multiple, and post-delivery referrals. Travel time and distance to facilities that could provide needed care increased two-fold on account of referrals compared to scenarios of going directly to the final facility, mostly travelling to these facilities by private cars/taxis (72.8 %). Prolonged/obstructed labour was the commonest obstetric indication for referral, with majority of referred pregnant women delivered via caesarean section (52.9 %). After adjustment, being married, not being registered for antenatal care at facility of care, presenting at night or with a foetus in distress increased the odds of referral. However, parity, presentation in the months following the commissioning of a new comprehensive EmOC facility or with abortion reduced the likelihood of being referred. Our findings underscore the need for health systems strengthening interventions that support women during referral and the importance of antenatal care and early booking to aid identification of potential pregnancy complications whilst establishing robust birth preparedness plans that can minimise the need for referral in the event of emergencies. Indeed, there are context-specific influences that need to be addressed if effective referral systems are to be designed

Caesarean section · Environmental health · Family medicine · Health facility · Health services · Medical emergency · Obstructed labour · Population · Pregnancy · Psychological intervention · Public health · Referral · Global Maternal and Child Health · Maternal and fetal healthcare · Medicine · Nursing