Obstetric referrals: the practice by community health workers

Abstract

Background: Maternal mortality is a major health challenge in Nigeria. Improper/late referral of obstetric patients is a major contributor to these deaths. This cross-sectional study documents the practice of referral of obstetric patients and the challenges faced by community health extension workers attending a Community Health Officers Training programme in a teaching hospital in Nigeria
Methods: Pretested self- administered questionnaires were administered to students undergoing the Community Health Officers training programme at the Jos University Teaching Hospital. Focused group discussions were also conducted.
Results: Majority of the respondents (93.8%) referred patients to other healthcare facilities and the reasons proffered for referring patients include complications (54.7%), for proper care (34.4%) and based on guidelines/protocol (6.3%). Majority of respondents 89.1%, 84.4% and 78.1% referred patients with eclampsia, abnormal lies and presentation and antepartum haemorrhage respectively while about half of the respondents referred primigravidae, grandmultigravidae and women with multiple gestation. Half of the respondents had encountered challenges while referring patients to other health facilities. The challenges highlighted during the group discussions in referring patients include absence of feedback from referred hospitals, insults from health workers at the referred centres, patients refusing to go to other hospitals due to lack of funds and complaints of poor treatment/care by health workers in those hospitals.
Conclusion: The practice of referrals of obstetric patients by community health workers is poor. Health workers should be trained on proper patient referral with the use of clearly written guidelines/protocols.

Keywords: Community health workers, Obstetrics, Practice, Referrals