Perceptions of health workers on the referral of women with obstetric complications: a qualitative study in rural Sierra Leone

Abstract

BackgroundSierra Leone has one of the highest maternal mortality ratios in the world. Timely and well-coordinated referrals are necessary to reduce delays in providing adequate care for women with obstetric complications. This study describes the perspectives of health workers in rural facilities in Sierra Leone concerning the referral of women with obstetric complications.MethodsWe conducted semi-structured group interviews with health care workers in nine peripheral health units in rural Sierra Leone regarding the referral of women with obstetric complications. Themes discussed were based on an interview guide. The data was analysed by systematic text condensation.ResultsPerspectives were grouped according to the following themes identified: 1) communication between health care workers; 2) underlying influences on decision-making; 3) women’s compliance to referral; 4) logistic constraints.ConclusionSeveral factors in rural Sierra Leone are perceived to complicate timely and adequate referral of women in need of emergency obstetric care. Notable among these factors are fear among women for being referred and fear among health care workers for having maternal deaths or severe obstetric complications at their own facilities. Furthermore, the decision-making of health care workers concerning referral is negatively influenced by an atmosphere of hierarchy between health care workers. Such factors must be considered in efforts to reduce maternal mortality.

The Constant Threat of Zoonotic and Vector-Borne Emerging Tropical Diseases: Living on the Edge

“…Amongst these are active surveillance (some supported by artificial intelligence) ( 140 – 142 ), leading to the rapid identification of novel pathogens by genome sequencing and phylogenetic tracing studies ( 36 , 105 , 107 , 143 – 146 ) based on computing methods to predict possible interspecies barriers spillover between humans and animals ( 147 ). Coupling biotechnological approaches with social sciences—the holistic understanding of humans and their interactions in the disease ecosystems—is also a critical element needed when studying emerging infectious diseases ( 148 , 149 ).…”