Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
BMC Health Serv Res. 2010 Dec 3;10:326. doi: 10.1186/1472-6963-10-326.
The functional referral system is important in backing-up antenatal, labour and delivery, and postnatal services in the primary level of care facilities. The aim of this study was 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.
A follow-up study was conducted in Rufiji rural district in Tanzania. A total of 1538 women referred from 18 primary level of care facilities during a 13 months period were registered and then identified at hospitals. Those not reaching the hospitals were traced and interviewed.
Out of 1538 women referred 70% were referred for demographic risks, 12% for obstetric historical 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.
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 the referral indications and strengthen counseling on birth preparedness and complication readiness.
在基层保健设施中，功能转诊系统对于支持产前、分娩和产后服务非常重要。本研究的目的是通过确定转诊建议后到达医院的妇女比例、转诊指征的适当性、不遵守的原因以及确定是否遵守转诊对围产期结局的影响来评估产妇转诊系统的有效性。
在坦桑尼亚的 Rufiji 农村地区进行了一项随访研究。在 13 个月的时间里，从 18 个基层保健设施共登记了 1538 名转诊妇女，然后在医院进行了识别。对于未到达医院的妇女进行了追踪和访谈。
在 1538 名转诊妇女中，70%是因为人口统计学风险，12%是因为产科历史风险，12%是因为产前并发症，5.5%是因为分娩和立即产后并发症。五次或更多次妊娠以及年龄<20 岁是最常见的转诊指征。因人口统计学风险而转诊的妇女中，符合率为 37%，而因其他原因转诊的妇女中，符合率超过 50%。对于不遵守转诊建议的妇女，近一半人提到经济限制是主要因素。不遵守转诊建议并没有显著增加围产期死亡的风险。
大多数产妇转诊是由于人口统计学风险所致，只有少数妇女符合转诊要求。为了提高产妇转诊的依从性，有必要审查转诊指征，并加强生育准备和并发症准备方面的咨询。
