Abstract:
Background: The functional referral system is important in backing-up antenatal, labour and delivery, and
postnatal services in the primary level of care facilities. The aim of this study was to evaluate the effectiveness of
the maternal referral system through determining proportion of women reaching the hospitals after referral advice,
appropriateness of the referral indications, reasons for non-compliance and to find out if compliance to referrals
makes a difference in the perinatal outcome.
Methods: A follow-up study was conducted in Rufiji rural district in Tanzania. A total of 1538 women referred from
18 primary level of care facilities during a 13 months period were registered and then identified at hospitals. Those
not reaching the hospitals were traced and interviewed.
Results: Out of 1538 women referred 70% were referred for demographic risks, 12% for obstetric historical risks,
12% for prenatal complications and 5.5% for natal and immediate postnatal complications. Five or more
pregnancies as well as age <20 years were the most common referral indications. The compliance rate was 37%
for women referred due to demographic risks and more than 50% among women referred in the other groups.
Among women who did not comply with referral advice, almost half of them mentioned financial constraints as
the major factor. Lack of compliance with the referral did not significantly increase the risk for a perinatal death.
Conclusion: Majority of the maternal referrals were due to demographic risks, where few women complied. To
improve compliance to maternal referrals there is need to review the referral indications and strengthen
counseling on birth preparedness and complication readiness.
