Maternity referral systems in developing countries: Current knowledge and future research needs

Murray, Susan; Pearson, Stephen

doi:10.1016/j.socscimed.2005.10.025

Cited by 151 publications

(186 citation statements)

References 43 publications

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“…Towards the end not even a single health facility equipped with 24×7 fully functional referral transport to service the pregnant women. A referral transport system must be managed professionally so that some basic interventions can be administered to patients even before they reach a health facility (31). The state government does not have any referral guidelines or standard protocols, to be followed by the CHCs or district hospital.…”

Section: Place Of Death Taken To 1 Facility (%) Taken To 2 Facilitiesmentioning

confidence: 99%

“…It is important to ensure that ambulance services are available to the entire population of a district or state. Neither time of the emergency, nor location of the pregnant woman, or cost should be factors dissuading families from calling for public referral transport services (31). More than half of the families claim out-of-pocket expenses for transportation and medicines (25).…”

Section: Place Of Death Taken To 1 Facility (%) Taken To 2 Facilitiesmentioning

confidence: 99%

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Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

Raj

Manthri

Sahoo

2015

Int J Health Policy Manag

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Background: An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP). Methods: A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based Maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010. A facility review was also conducted in 15 of the 16 block level and district health facilities to collect information on preparedness of the facilities for treating obstetric complications including referral transportation. A descriptive analysis was carried out using ratios and percentages to analyze the availability of basic facilities which may lead to maternal deaths. Results: It was found that there were only 10 ambulances available at 15 facilities against 19 required as per Indian Public Health Standards (IPHS). About 47% of the deaths took place in a facility, 30% enroute to a health facility and 23% at home. Twenty five percent of women were taken to one facility, 32% were taken to two facilities, and 25% were taken to three facilities while 19% were not taken to any facility before their death. Sixteen percent of the pregnant women could not arrange transportation to reach any facility. The mean time to make arrangements for travel from home to facility-1 and facility-2 to facility-3 was 3.1 hours; whereas from facility-1 to facility-2 was 9.9 hours. The mean travel time from home to facility-1 was 1 hour, from facility-1 to facility-2 was 1.4 hours and facility-2 to facility-3 was 1.6 hours. Conclusion:The public health facility review and MDR, clearly indicates that the inter-facility transfers appropriateness and timeliness of referral are major contributing factor for maternal deaths in Unnao district, UP. The UP Government, besides strengthening Emergency Obstetric and Newborn Care (EmONC) and Basic Emergency Obstetric and Newborn Care (BEmONC) services in the district and state as a whole, also needs to focus on developing a functional and effective referral system on a priority basis to reduce the maternal deaths in Unnao district.

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Section: Place Of Death Taken To 1 Facility (%) Taken To 2 Facilitiesmentioning

confidence: 99%

Section: Place Of Death Taken To 1 Facility (%) Taken To 2 Facilitiesmentioning

confidence: 99%

Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

Raj

Manthri

Sahoo

2015

Int J Health Policy Manag

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“…17 The majority of women having hospital-based delivery, especially in African countries, are not referred by a health professional but are self-referrals. 25,33 In part, this reflects their lack of confidence in lower level care and results in congestion of hospitals. 33 However, even when referred from another facility, either a rural clinic or facility without emergency obstetric care capacity, women arrive in severe clinical condition.…”

Section: Phase IImentioning

confidence: 99%

“…25,33 In part, this reflects their lack of confidence in lower level care and results in congestion of hospitals. 33 However, even when referred from another facility, either a rural clinic or facility without emergency obstetric care capacity, women arrive in severe clinical condition. 25 Reasons for this include structural and process deficiencies -delayed referral, the high cost of emergency obstetric care or lack of public transport.…”

Section: Phase IImentioning

confidence: 99%

“…25 Reasons for this include structural and process deficiencies -delayed referral, the high cost of emergency obstetric care or lack of public transport. 34 The flaws in the referral system lead to patients being shunted from one facility to another, 13,33 when facilities are unable to deal with obstetric complications 35 or they lack trained health professionals. The number of referrals onwards before a woman reaches an appropriate facility influences survival.…”

Section: Phase IImentioning

confidence: 99%

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The role of delays in severe maternal morbidity and mortality: expanding the conceptual framework

Pacagnella¹,

Cecatti²,

Osis³

et al. 2012

Reproductive Health Matters

175

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Ambulance services as part of the district health system in low‐income countries: a feasibility study from Cambodia

Jacobs

Men²,

Sam³

et al. 2015

Health Planning & Management

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Maternity referral systems in developing countries: Current knowledge and future research needs

Cited by 151 publications

References 43 publications

Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

The role of delays in severe maternal morbidity and mortality: expanding the conceptual framework

Ambulance services as part of the district health system in low‐income countries: a feasibility study from Cambodia

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