ArticleBMJ open2020
Perspectives of health workers on the referral of women with obstetric complications: a qualitative study in rural Sierra Leone.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 7 citations in OpenAlex.
- Determinants of poor access to health care among women of reproductive age in Sierra Leone: a cross-sectional study.BMC health services research · 2025Article
- Article
- Challenges of health workers in primary health facilities in implementing obstetric emergency referrals to save women from death in Indonesia: A qualitative study.Belitung nursing journal · 2024Article
- A Sierra Leone 2021 Midwifery Clinical Training Needs Assessment: A Call to Action to Augment Clinical Precepting.Annals of global health · 2023Article
- The Constant Threat of Zoonotic and Vector-Borne Emerging Tropical Diseases: Living on the Edge.Frontiers in tropical diseases · 2021Article
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Authors and funding
7 authors at 3 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesSierra Leone has one of the highest maternal mortality ratios in the world. Timely and well-coordinated referrals are necessary to reduce delays in providing adequate care for women with obstetric complications. This study describes factors affecting timely and adequate referral of women with obstetric complications in rural areas of Sierra Leone as viewed by health workers in rural health facilities.
designQualitative research with semi-structured interviews using open-ended questions. Data were analysed by systematic text condensation.
settingInterviews were held in nine peripheral health units in rural Sierra Leone.
participants19 health workers including nurses, midwives and clinical health officers participated in nine interviews.
resultsFrom the interviews, four major themes describing possible factors of delay in referral of women in need of emergency obstetric care emerged: (1) communication between healthcare workers; (2) underlying influences on decision-making; (3) women's compliance to referral and (4) logistic constraints.Several factors in rural Sierra Leone are perceived to complicate timely and adequate referral of women in need of emergency obstetric care. Notable among these factors are fear among women for being referred and fear among healthcare workers for having maternal deaths or severe obstetric complications occurring at their own facilities. Furthermore, decision-making of healthcare workers whether to refer a woman or not is negatively influenced by a hierarchical culture with high power distance between healthcare workers.
conclusionFactors identified that complicate timely and adequate referral of women in need of emergency obstetric care must be considered in efforts to reduce maternal mortality. Possible interventions that may reduce delay in referral include increased communication by mobile phones between health workers for advice and feedback regarding referrals, involvement of influential stakeholders to increase women's compliance to referral, and consistent use of standardised management protocols.
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