Martey J O, Djan J O, Twum S, Browne E N, Opoku S A
Kumasi Prevention of Maternal Mortality (PMM) Team School of Medical Sciences, University of Science and Technology, Kumasi, Ghana.
West Afr J Med. 1998 Apr-Jun;17(2):58-63.
A study of referrals due to obstetrical complications from the Ejisu district, Ashanti region, Ghana was done to determine the institutions that receive them, their outcome and the effectiveness of the referral system. This formed part of a multidisciplinary research on the prevention of maternal mortality in the district. It covered 15 health facilities in the district. The receiving institutions identified in the study were Komfo Anokye teaching Hospital (KATH) in Kumasi, Agogo Presbyterian Hospital in the neighbouring Ashanti Akim district and the St. Michael's Hospital at Pramso in the same district. In the period under review, there were 192 referrals from the district, 139 to KATH with 87 (63%) reporting, 19 to Pramso with 14 (74%) reporting and 34 to Agogo with 17 (50%) reporting. The 3 most important complications referred were maternal haemorrhage (29%), high-risk pregnancy (24%) and delayed second stage (21%). The referring institutions had a defaulting rate varying from 8-56% with a median of 42%. This study did not specifically investigate the factors influencing the high defaulting rates in some institutions. However, focus-group discussions (FGDs) held in selected communities revealed the following factors as inhibiting the utilization of health services: * prohibitive hospital fees; * illegal fees and bribes; * irregular transport and uncooperative drivers; * poor and unmotorable roads; * lack of drugs and essential supplies and; * negative staff attitudes. Those health facilities with low defaulting rates had their own transport or were close to major trunk roads. From the study, the referral system was very weak. It is also possible that some of the referrals reported at the receiving institutions but were not classified as such. Interventions to improve the situation are currently being implemented.
对加纳阿散蒂地区埃久苏区因产科并发症而进行的转诊情况进行了一项研究，以确定接收转诊的机构、转诊结果以及转诊系统的有效性。这是该地区预防孕产妇死亡多学科研究的一部分。研究覆盖了该地区的15个卫生设施。研究中确定的接收机构有库马西的孔福·阿诺凯教学医院（KATH）、邻近的阿散蒂阿金区的阿戈戈长老会医院以及同一区普拉姆索的圣迈克尔医院。在审查期间，该地区有192例转诊，其中139例转诊至KATH，87例（63%）有反馈；19例转诊至普拉姆索，14例（74%）有反馈；34例转诊至阿戈戈，17例（50%）有反馈。转诊的3个最重要并发症是产后出血（29%）、高危妊娠（24%）和第二产程延长（21%）。转诊机构的未反馈率在8%至56%之间，中位数为42%。本研究未具体调查影响某些机构高未反馈率的因素。然而，在选定社区进行的焦点小组讨论揭示了以下阻碍卫生服务利用的因素：高昂的医院费用；非法收费和贿赂；交通不便且司机不合作；道路状况差且无法通行；药品和基本物资短缺；以及工作人员态度消极。那些未反馈率低的卫生设施有自己的交通工具或靠近主要干道。从研究来看，转诊系统非常薄弱。也有可能一些在接收机构反馈的转诊病例未被如此分类。目前正在实施改善这种情况的干预措施。
