Nuamah Gladys Buruwaa, Agyei-Baffour Peter, Akohene Kofi Mensah, Boateng Daniel, Dobin Dominic, Addai-Donkor Kwasi
School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
Int J Equity Health. 2016 Jul 22;15(1):117. doi: 10.1186/s12939-016-0408-7.
Obstetric referrals, otherwise known as maternal referrals constitute an eminent component of emergency care, and key to ensuring safe delivery and reducing maternal and child mortalities. The efficiency of Obstetric referral systems is however marred by the lack of accessible transportation and socio-economic disparities in access to healthcare. This study evaluated the role of socio-economic factors, perception and transport availability in honouring Obstetric referrals from remote areas to referral centres.
This was a cross-sectional study, involving 720 confirmed pregnant women randomly sampled from five (5) sub-districts in the Amansie west district in Ghana, from February to May 2015. Data were collected through structured questionnaire using face-to-face interviewing and analyzed using STATA 11.0 for windows. Logistic regression models were fitted to determine the influence of socio-demographic characteristics and pregnancy history on obstetric referrals.
About 21.7 % of the women studied honoured referral by a community health worker to the next level of care. Some of the pregnant women however refused referrals to the next level due to lack of money (58 %) and lack of transport (17 %). A higher household wealth quintile increased the odds of being referred and honouring referral as compared to those in the lowest wealth quintile. Women who perceived their disease conditions as emergencies and severe were also more likely to honour obstetric referrals (OR = 2.3; 95 % CI = 1.3, 3.9).
Clients' perceptions about severity of health condition and low income remain barriers to seeking healthcare and disincentives to honour obstetric referrals in a setting with inequitable access to healthcare. Implementing social interventions could improve the situation and help attain maternal health targets in deprived areas.
产科转诊，也称为孕产妇转诊，是急诊护理的重要组成部分，是确保安全分娩以及降低孕产妇和儿童死亡率的关键。然而，产科转诊系统的效率因缺乏便捷的交通以及获得医疗服务方面的社会经济差异而受到影响。本研究评估了社会经济因素、认知以及交通可用性在落实从偏远地区到转诊中心的产科转诊方面所起的作用。
这是一项横断面研究，于2015年2月至5月从加纳阿曼西西区的5个分区随机抽取720名确诊孕妇。通过使用面对面访谈的结构化问卷收集数据，并使用适用于Windows的STATA 11.0进行分析。采用逻辑回归模型来确定社会人口学特征和妊娠史对产科转诊的影响。
约21.7%的研究对象孕妇接受了社区卫生工作者的转诊，前往更高一级的医疗机构。然而，一些孕妇因缺钱（58%）和缺乏交通工具（17%）而拒绝转诊至更高一级医疗机构。与最贫困的五分位数家庭相比，家庭财富处于较高五分位数的孕妇被转诊并接受转诊的几率更高。认为自己病情紧急且严重的孕妇也更有可能接受产科转诊（比值比=2.3；95%置信区间=1.3, 3.9）。
在医疗服务获取不公平的情况下，患者对健康状况严重性的认知和低收入仍然是寻求医疗服务的障碍以及接受产科转诊的阻碍因素。实施社会干预措施可能会改善这种情况，并有助于在贫困地区实现孕产妇健康目标。
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