Delay In Inter-Facility Emergency Obstetric Referrals And Associated Factors In West Shoa Zone Public Hospitals, Oromia National Regional State, Central Ethiopia

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.