Patterns, travel to care and factors influencing obstetric referral: Evidence from Nigeria’s most urbanised state.
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Date
2021
Authors
Banke-Thomas, A
Avoka, C
Olaniran, A
Balogun, M
Wright, O
Ekirin, O
Benova, L
Journal Title
Journal ISSN
Volume Title
Publisher
Social Science & Medicine
Abstract
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.
Description
Scholarly articles
Keywords
Research Subject Categories::MEDICINE::Social medicine::Public health medicine research areas::Public health science , Health systems , Pregnant women , Obstetric emergencies , Lagos State , Research Subject Categories::MEDICINE
Citation
Banke-Thomas A, Avoka C, Olaniran A, Balogun M, Wright O, Ekerin O, Benova L. Patterns, travel to care and factors influencing obstetric referral: Evidence from Nigeria’s most urbanised state. Social Science & Medicine 291 (2021) 114492.