Appropriateness of maternal referral system and its associated factors in Eastern Ethiopia: a facility-based cross-sectional study
BackgroundGiven majority of obstetric complications are often unpredictable, an appropriate maternal referral system is crucial to manage life-threatening obstetric complications and prevent maternal deaths. Although Ethiopia is one of the countries with high maternal deaths, there is a paucity of d...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Global Women's Health |
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| author | Betelhem Mengist Sharew Agumasie Semahegn Agumasie Semahegn Agumasie Semahegn Shegaye Yibabie Damtie Nigus Kassie Worku Abera Kenay Tura Abera Kenay Tura Abera Kenay Tura |
| author_facet | Betelhem Mengist Sharew Agumasie Semahegn Agumasie Semahegn Agumasie Semahegn Shegaye Yibabie Damtie Nigus Kassie Worku Abera Kenay Tura Abera Kenay Tura Abera Kenay Tura |
| author_sort | Betelhem Mengist Sharew |
| collection | DOAJ |
| description | BackgroundGiven majority of obstetric complications are often unpredictable, an appropriate maternal referral system is crucial to manage life-threatening obstetric complications and prevent maternal deaths. Although Ethiopia is one of the countries with high maternal deaths, there is a paucity of data on the appropriateness of maternal referrals. The aim of this study was to assess the appropriateness of maternal referrals and its associated factors in eastern Ethiopia.MethodsA facility-based cross-sectional study was conducted among randomly selected women who were referred to the major referral hospitals during pregnancy, childbirth or the postpartum. Data on maternal conditions and referral related information were collected through review of the medical records using structured checklist. Data were entered into EpiData 3.1 and exported to SPSS 20 for analysis. Bivariable and multivariable logistic regression analyses were fitted to identify factors associated with the appropriateness of referrals using adjusted odds ratio (AOR) along with 95% confidence interval (CI). Significant association was declared at p < 0.05.ResultsOf 422 maternal referrals reviewed, only 10.1% (95% CI: 7.1–13.1%) were appropriate. Referrals on working days (AOR = 3.77; 95% CI: 1.29–10.99), which arrived during working time (AOR = 3.64; 95% CI: 1.54–8.61), referred from governmental hospitals (AOR = 5.69; 95% CI: 1.33–24.32) or from private/non-governmental organization facilities (AOR = 2.94; 95% CI: 1.09–7.93), those written on standard referral forms (AOR = 5.52; 95% CI: 1.71–17.85), and which contains referral feedback (AOR = 4.90; 95% CI: 1.93–12.47) were more likely to be appropriate maternal referral.ConclusionOnly one in ten maternal referrals from public health facilities in eastern Ethiopia were found to be appropriate. Referrals on working days and time, from governmental hospitals, private facilities, standard referral forms used, and those with referral feedback were found to be appropriate. Strengthening referral system through focusing on non-working hours and during weekends as well as co-creating standards forms are essential for making maternal referrals appropriate and effective in reducing maternal deaths. |
| format | Article |
| id | doaj-art-1dba79ecdf91420cb4cae67fc547e625 |
| institution | OA Journals |
| issn | 2673-5059 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
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| spelling | doaj-art-1dba79ecdf91420cb4cae67fc547e6252025-08-20T01:51:55ZengFrontiers Media S.A.Frontiers in Global Women's Health2673-50592025-05-01610.3389/fgwh.2025.14731911473191Appropriateness of maternal referral system and its associated factors in Eastern Ethiopia: a facility-based cross-sectional studyBetelhem Mengist Sharew0Agumasie Semahegn1Agumasie Semahegn2Agumasie Semahegn3Shegaye Yibabie Damtie4Nigus Kassie Worku5Abera Kenay Tura6Abera Kenay Tura7Abera Kenay Tura8Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, EthiopiaSchool of Nursing, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaCentre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, EthiopiaDepartment of Population Family, and Reproductive Health, School of Public Health, University of Ghana, Accra, GhanaSchool of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, EthiopiaDepartment of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, EthiopiaSchool of Nursing, College of Health and Medical Sciences, Haramaya University, Harar, EthiopiaDepartment of Obstetrics and Gynaecology, University Medical Centre Groningen, University of Groningen, Groningen, NetherlandsDepartment of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United KingdomBackgroundGiven majority of obstetric complications are often unpredictable, an appropriate maternal referral system is crucial to manage life-threatening obstetric complications and prevent maternal deaths. Although Ethiopia is one of the countries with high maternal deaths, there is a paucity of data on the appropriateness of maternal referrals. The aim of this study was to assess the appropriateness of maternal referrals and its associated factors in eastern Ethiopia.MethodsA facility-based cross-sectional study was conducted among randomly selected women who were referred to the major referral hospitals during pregnancy, childbirth or the postpartum. Data on maternal conditions and referral related information were collected through review of the medical records using structured checklist. Data were entered into EpiData 3.1 and exported to SPSS 20 for analysis. Bivariable and multivariable logistic regression analyses were fitted to identify factors associated with the appropriateness of referrals using adjusted odds ratio (AOR) along with 95% confidence interval (CI). Significant association was declared at p < 0.05.ResultsOf 422 maternal referrals reviewed, only 10.1% (95% CI: 7.1–13.1%) were appropriate. Referrals on working days (AOR = 3.77; 95% CI: 1.29–10.99), which arrived during working time (AOR = 3.64; 95% CI: 1.54–8.61), referred from governmental hospitals (AOR = 5.69; 95% CI: 1.33–24.32) or from private/non-governmental organization facilities (AOR = 2.94; 95% CI: 1.09–7.93), those written on standard referral forms (AOR = 5.52; 95% CI: 1.71–17.85), and which contains referral feedback (AOR = 4.90; 95% CI: 1.93–12.47) were more likely to be appropriate maternal referral.ConclusionOnly one in ten maternal referrals from public health facilities in eastern Ethiopia were found to be appropriate. Referrals on working days and time, from governmental hospitals, private facilities, standard referral forms used, and those with referral feedback were found to be appropriate. Strengthening referral system through focusing on non-working hours and during weekends as well as co-creating standards forms are essential for making maternal referrals appropriate and effective in reducing maternal deaths.https://www.frontiersin.org/articles/10.3389/fgwh.2025.1473191/fullappropriatenessmaternal referral systemEastern Ethiopiareferralsmaternal |
| spellingShingle | Betelhem Mengist Sharew Agumasie Semahegn Agumasie Semahegn Agumasie Semahegn Shegaye Yibabie Damtie Nigus Kassie Worku Abera Kenay Tura Abera Kenay Tura Abera Kenay Tura Appropriateness of maternal referral system and its associated factors in Eastern Ethiopia: a facility-based cross-sectional study Frontiers in Global Women's Health appropriateness maternal referral system Eastern Ethiopia referrals maternal |
| title | Appropriateness of maternal referral system and its associated factors in Eastern Ethiopia: a facility-based cross-sectional study |
| title_full | Appropriateness of maternal referral system and its associated factors in Eastern Ethiopia: a facility-based cross-sectional study |
| title_fullStr | Appropriateness of maternal referral system and its associated factors in Eastern Ethiopia: a facility-based cross-sectional study |
| title_full_unstemmed | Appropriateness of maternal referral system and its associated factors in Eastern Ethiopia: a facility-based cross-sectional study |
| title_short | Appropriateness of maternal referral system and its associated factors in Eastern Ethiopia: a facility-based cross-sectional study |
| title_sort | appropriateness of maternal referral system and its associated factors in eastern ethiopia a facility based cross sectional study |
| topic | appropriateness maternal referral system Eastern Ethiopia referrals maternal |
| url | https://www.frontiersin.org/articles/10.3389/fgwh.2025.1473191/full |
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