Referrals for obstetrical complications from Ejisu district, Ghana

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Health Systems Research

Background:

• Maternal mortality remains a significant public health challenge in many low-resource settings.
• Effective referral systems are crucial for managing obstetric emergencies and improving maternal outcomes.
• The Ejisu district in Ghana's Ashanti region faces challenges in its obstetric referral system.

Purpose of the Study:

• To evaluate the effectiveness of the obstetric referral system in Ghana's Ejisu district.
• To identify receiving institutions, referral outcomes, and factors influencing the referral process.
• To inform interventions aimed at reducing maternal mortality.

Main Methods:

• A multidisciplinary study analyzing 192 obstetric referrals from 15 health facilities in Ejisu district.
• Data collection included referral destinations, patient reporting rates, and reasons for referral.
• Focus-group discussions explored community-level barriers to healthcare utilization.

Main Results:

• Referral rates varied significantly, with Komfo Anokye Teaching Hospital (KATH) receiving the most referrals.
• Maternal hemorrhage, high-risk pregnancy, and delayed second stage were the primary referral complications.
• High defaulting rates (median 42%) were observed, influenced by financial, logistical, and attitudinal barriers.

Conclusions:

• The obstetric referral system in Ejisu district is weak, with significant defaulting rates.
• Barriers to care include high costs, poor transport, inadequate roads, and negative staff attitudes.
• Interventions are underway to strengthen the referral system and improve maternal health outcomes.