Self-referrals and associated factors among laboring mothers at Dilla University Referral Hospital, Dilla, Gedeo Zone, Ethiopia: a cross-sectional study

Abstract

Background When medical cases are difficult to manage at the level of primary health care units (PHCU), formal referral assists patients transferring to a higher level of care. In contrast, self-referral and bypassing are synonymously used in literature to describe the phenomenon of patients skipping their units to get basic medical services, even though they are close to their residence. Though proper and timely referral prevents the majority of deaths from obstetric complications in developing countries, more than 50% of referrals are self-referral trends. Such patient practice is increasingly becoming a concern for many health-care systems. Objective To assess the magnitude of self-referrals and associated factors among laboring mothers at Gedeo Zone, Ethiopia. Methods Facility-based cross-sectional study was conducted from August 1-September 30/2021 among laboring mothers at Dilla University Referral Hospital. A systematic random sampling technique was used to select 375 laboring mothers. Data were collected using a face-to-face interview with a structured questionnaire. Data were entered into a computer using Epi-Data 4.6 statistical program and then exported to STATA version 16 for analysis. In bivariate analysis variables with a p-value ≤ 0.25 were selected as a candidate variable for the multivariable analysis. P-value < 0.05 at 95% confidence interval considered as a statistically significant associations in the multivariable analysis. Result 375 eligible mothers participated in the study, with a response rate of 98.16%. The magnitude of self-referrals among laboring mothers was 246 (65.6%) with 95% CI (0.60–0.70). Time ≥ 30 min to reach nearby facilities (AOR = 1.74, 95% CI, 1.08, 2.81), having no medicine supplies at nearby facilities (AOR = 1.75, 95% CI, 1.08, 2.82), having no equipment and supplies at nearby facilities (AOR = 1.70, 95% CI, 1.03, 2.78), having ANC visits ˃ 3 times (AOR = 0.29, 95% CI, 0.15, 0.55) and having poor perception of health provider technical competence at nearby facilities (AOR = 2.97, 95% CI, 1.83, 4.79) were found as significant factors for self-referral. Conclusion The magnitude of self-referral was high. Frequent Antenatal visits were protective, however time to reach the nearest facilities, perception towards health care providers, medicine, equipment and supplies at the nearest facilities were positive influencing factors. Government stakeholders should keep working on improving the quality of health service, especially at primary health care units(PHCU).

Status, associated factors, and reasons for bypassing the childbirth center among postpartum women in the Dire Dawa Administration, Ethiopia: A Mixed Study

“…However, the nding of this study was lower than studies conducted in India (37.7%) (24), Madhya Pradesh, India (37%) (24), Nepal (70.2%) (25), Kenya (76.7%) (26), Tanzania (41.8%) (29), and two studies in south Ethiopia, Hosana (67%) (18), and Dilla (65.6%) (37). This inconsistency might be due to differences in study times, sample size, and some socio-demographic characteristics like age, educational level, and residence area.…”

“…Similarly, women with no formal education and who lacked obstetric care needs during their antenatal care were more likely to bypass a childbirth health facility. This was incongruent with studies (24,26,27,29,37): "Variation in women's education level (20) and the functionality of a health care facility in terms of supplies, equipment, and the competence of health care workers can be attributed to bypassing the nearest health care facility." This might be due to the fact that uneducated women might have a lack of awareness about the obstetrics service differences given each level of health care facilities and ought to weigh the risk of bypassing the nearby childbirth health facility instead of complaining about the perceived and real limitations there.…”

“…The odds of bypassing a childbirth health facility were higher among older women (35 or older ) and rural residents. The possible reason might be related to the fact that older women might relate their past obstetric experiences with the present, and those rural women might lack some sort of information compared to urban ones (18,20,28,37).…”

Magnitude and Predictors of self-care Practices among Patients with Diabetes Mellitus in Central Ethiopia: the health belief model perspective

“…Although numerous studies have been conducted in Ethiopia to assess factors associated with diabetic self-care practices, the health belief model (HBM) has not been widely used [17][18][19][20][21][22][23][24][25][26]. The HBM is essential for comprehending human behavior in self-care practices.…”

The nature of psychiatric problems in Primary health Care centers: the experience of a Community Mental Health Center in northeast of Iran

“…Self-referral can increase costs and shrink the resources of the healthcare organization. Due to the increasing number of patients in higher levels of the healthcare system (without obeying the referral system), work exhaustion among physicians (especially specialists) and endangered patient safety are also expected (19). In Iran, patients of CMHCs are supposed to be referred by primary care physicians or have been admitted to a psychiatric hospital in the past (13).…”