Outcomes of Pregnancy-Related Referrals From Rural Health Facilities to Two Central Hospitals in Harare, Zimbabwe: A Prospective Descriptive Study
BackgroundBetween the years 2000 and 2017, the global maternal mortality rate dropped by 38% however, 94% of all maternal deaths still emanated from low and lower-middle-income countries. Rural women at a significantly higher risk of dying from pregnancy when compared to women living in urban settings and early detection of complications as well as prompt referral to higher levels of care can reduce the associated maternal and perinatal mortality. This study aimed to determine the maternal and
... erinatal outcomes of pregnancy-related referrals from rural health facilities to two central hospitals in Harare, Zimbabwe.MethodsA prospective descriptive study was conducted using a sample of 206 patients. All mothers who were referred from rural healthcare facilities were recruited for participation. Data were extracted from patient notes using a structured questionnaire and missing information was obtained from the mother after she had recovered. Bivariate analysis was done using IBM SPSS.ResultsThe average age of study participants was 27.4±7.7 years. 87.4% were booked and 81.6% presented to the tertiary facility with their referral notes. The major reasons for referral were previous cesarean section (20.4%) and hypertensive disorders in pregnancy (18.4%). There were nine maternal deaths thus a case fatality rate of 4.4% while the perinatal mortality rate was 151/1000 live births. Young mothers were more likely to have adverse perinatal outcomes and primiparous mothers were more likely to have a blood transfusion. Mothers who traveled for >100km to the tertiary facility and mothers who did not attend any antenatal visit were more likely to be transfused. Delivering at the rural health facility was significantly associated with receiving a blood transfusion at the tertiary facility. Mothers who did not attend antenatal clinic visits were more likely to have negative perinatal outcomes.ConclusionThe proportion of obstetric patients being referred from rural facilities to tertiary institutions for complications in Zimbabwe reveals how primary and secondary healthcare facilities are falling short of offering the services they should be offering. Equipping these facilities with skilled human resources as well as contemporary equipment could help decongest the central hospitals, reduce the adverse maternal and perinatal outcomes.