Abstract:
Background: Delay in reaching emergency obstetric care facilities results in the occurrence of
complications. There is a scarcity of information about the magnitude and factors associated with inter facility emergency obstetric referral delay in Ethiopia in general and in West Shoa zone public hospitals
Objective: To assess magnitude of delay in reaching emergency obstetric care facilities and associated
factors among mothers referred to West Shoa Zone public hospitals, Ethiopia, 2021
Methods: An explanatory sequential mixed method design was conducted among 422 referred mothers
and 17 key informants. A simple random sampling technique was employed to select five hospitals from
eight hospitals in the West Shoa Zone. A systematic random sampling technique was used to enroll 422
study participants. An interviewer administered structured questionnaire was used to collect data. The
qualitative data was collected through face-to-face interviews using an open-ended questionnaire from
key informants. Data was entered into EPI Data version 3.1 and SPSS version 25 was used for analysis.
Logistic regression was fitted to identify the presence of significant associations, and an adjusted odds
ratio with 95%CI was employed for the strength and direction of association between the independent
and dependent variables. A P-value of <0.05 was used to declare statistical significance. For qualitative
data, the responses were recorded with an audio recorder, and a thematic analysis was employed.
Results: In this study, about 219 (52.4%) (95% CI: 47.4%-56.7%) of mothers were unable to arrive at
the receiving hospitals within two hours from the referring units. Returning home after referred (AOR:
3.42, 95% CI: 1.68-6.93), inaccessibility of good roads between the two units (AOR: 2.75, 95%CI: 1.54-
4.92), distance ≥10 km between the two units (AOR: 4.84, 95%CI: 2.08-11.25), monthly income ≤ 1000
birr (AOR: 3.14, 95%CI: 1.19-8.26), refusing the referral (AOR: 2.88, 95%CI: 1.20-6.90), mother‘
s
primary education (AOR: 2.04,95%CI:1.10-3.79), husband‘s primary education (AOR: 1.89, 95%CI:
1.01-3.54), staying a long time at referring units (AOR: 9.57, 95%CI: 5.57-16.42), and decision maker
of accepting referral (AOR: 4.44, 95%CI: 1.67-11.80) were significantly associated with inter-facility
referral delays.
Conclusion and Recommendation: In this study, the magnitude of the inter-facility referral delay was
high. Furthermore, the decision-making capacity of mothers, returning home after being referred, refusal
of referrals, unavailability of good roads between the two units, staying a long time at referring units,
and the distance ≥ 10 km between the two units were found to be significantly associated with interfacility referral delay. All stakeholders should advise mothers on complication readiness.
