Factors Influencing The Timing of Compliance With Nonemergency Obstetric Referrals at The Tamale Teaching Hospitals

ABSTRACT

Background: It is known that a significant reduction in maternal mortality cannot be attained without an effective and efficient referral system. Maternal mortality in the Northern Region remains high with the Tamale Metropolis alone recording 76 out of 133 deaths in 2016. Anecdotal evidence in the region suggests that majority of referred maternal patients do not comply promptly with referral recommendation especially during non-emergency referrals. This could be a contributory factor to the high institutional maternal deaths recorded in the region. Objective: the objective of this study was to determine the factors influencing the timing of compliance with non-emergency obstetric referrals at the Tamale Teaching Hospital. Methods: The study was conducted at the Tamale Teaching Hospital Obstetrics Unit from 4th June to 14 th June 2018. It was an analytical cross sectional quantitative study. The data were obtained from 213 participants who were recruited through simple random sampling. They were interviewed using a data extraction tool adapted and modified from the WHO rapid assessment of referral care systems. Descriptive statistics, bivariate and multivariate analyses were performed at 95% confidence interval and the results presented in tables and charts. Results: The study found that about one in five (22.1%) of pregnant women do not comply early with non-emergency referrals to the Tamale Teaching Hospital. Age, marital status, health insurance status, severity of condition, journey time and road network were significant factors found to influence the timing of compliance. Conclusions: The study concluded that there was late referral compliance among some pregnant women in non-emergency situations. Hypertensive disorders, previous caesarean section and anaemia in pregnancy were the leading conditions that necessitated referrals. Age, marital status, health insurance status, severity of condition, journey time and road network predicted timing of compliance with non-emergency obstetric referrals at the Tamale Teaching Hospital and therefore recommended v the need for the coordination of referral processes within the region and patient education through community participation.