Assessment of the referral process for emergency obstetric care in basic facilities in Bungoma County, Kenya

Abstract

Background: Emergency Obstetric Care (EmOC) refers to a package of essential healthcare services that should be available to all women during pregnancy, labour and after birth. Women who develop obstetric complications should access timely and appropriate care, including referral so as to prevent pregnancy-related morbidities and mortalities, which has largely been attributed to delays and poor management in the healthcare referral system. The World Health Organization highlights that any inability in the referral system to securely transport pregnant women to an appropriate level of care with competent personnel when complications arise can have adverse effects on maternal and fetal outcomes. Objectives: The study objectives included: to determine the influence of communication and transport on the emergency obstetric referral process; to assess the perceived competence on the use of emergency obstetric signal functions among healthcare workers; to determine the availability of supplies and equipment in the provision of EmOC; and to assess client satisfaction with obstetric emergency referral care from level 3 and 4 facilities in Bungoma County. Methods: A cross-sectional design was adopted. The study was conducted in Bungoma County from August 2022 to December 2022. Multistage sampling was used, comprising of stratified random sampling (for levels of healthcare - levels 3 and 4 facilities) and simple random sampling (for healthcare workers and women participants). The study participants included healthcare workers (n=161) in Level 3 and 4 obstetric units, and women (n=379) with obstetric emergencies referred from these facilities. Data was collected using questionnaires and observation checklist. Data was analyzed using descriptive statistics, including measures of central tendency and inferential statistics as applicable, and presented in summary tables. Results: Effective communication and transport was strongly associated with quality EmOC during referral process (linear regression coefficient, T=3.24, p=0.001); healthcare workers' perceived competence on the use of signal functions was statistically associated with the provision of quality EmOC (linear regression coefficient, T=7.15, p=0.003); the availability of supplies and equipment was also strongly associated with the quality of EmOC services (Chi-square value=240.05, p=0.002); Clients’ overall satisfaction with the referral process had a significant relationship with the quality of EmOC services (logistic coefficient value=0.088, p=0.002). Overall, the findings were statistically significant, highlighting a significant association between the study variables and the quality of EmOC services during obstetric referral process. Conclusion: Effective communication and transport, healthcare workers’ perceived competence on EmOC signal functions, and the availability of supplies and equipment have a direct influence on the referral process of emergency obstetric care, and the overall client satisfaction. Clients’ (women) satisfaction was positively associated with Quality EmOC services during referral process. Recommendations: The study recommends that the county ensures effective communication and transport mechanisms and constant availability of supplies and functional equipment for obstetric referrals; ensure regular support supervision and continuous professional development to enhance HCWs competence on EmOC signal functions; and to improve the overall emergency obstetric referral care in basic facilities so as to meet clients’ expectations/satisfaction. A qualitative study is also warranted to provide in-depth understanding of clients’ experiences and/or salient issues on satisfaction.