Self-referral practice and associated factors among women who gave birth in south Gondar zone primary hospitals, northwest Ethiopia, 2022.

Abstract

Abstract Background: Patient self-referral is a situation when patients refer themselves to upper level health facilities without having to see anyone else first or without being told to refer themselves by another health professional. Self-referral leads to a diminished quality of health care services. However, a significant number of women referred themselves to hospitals without having referral sheets globally, including Ethiopia as well as the study area. Objective: This study aimed at assessing self-referral practice and associated factors among women who gave birth in south Gondar zone primary hospitals, Northwest, Ethiopia, 2022. Methods: An institution based cross-sectional mixed methods study was conducted among women who gave birth in south Gondar zone primary hospitals from June 1 to July 15, 2022. Semi-structured interviewer administered questionnaires were used to gather quantitative data from 561 participants who were selected by a systematic random sampling technique. Quantitative data were entered into EpiData version 4.6.0.4 and then exported to the statistical software SPSS version 25 for further analysis. Data were analyzed using logistic regression model. In bivariable analysis p-value less than 0.25 was used to select candidate variables for multivariable analysis. AOR with 95% CI was determined to see the strength of association, and P<0.05 was taken as level of statistical significance. Interview guides were used to collect qualitative data from purposely selected 6 key informants. Thematic analysis using open code version 4.02 software was applied for qualitative data analysis. Results: The overall magnitude of self-referral was 45.6%, with a 95% CI (41.549.9%).

No and 1-3 ANC follow up (AOR = 2.98, 95%CI: 1.62-5.48) and (AOR = 1.56, 95%CI: 1.02-2.38), respectively, were statistically significant factors associated with self-referral practice, as were poor knowledge of the referral system (AOR = 4.02, 95%CI: 2.29-7.07) and use of public or private transportation (AOR = 2.26, 95%CI: 1.39-3.67). The reasons for self-referral practice reported in the KII were no skilled provider in the health center, lack of medical equipment and drugs, lack of trust at health center, lack of privacy in the health centers and the presence of better service in the hospital. Conclusions: The magnitude of slef-referral in the study area was fair as compaired to other studies. ANC follow up, women‘s knowledge of the referral system, and mode of transport were factors significantly associated with self-referral practice. Therefore, developing awareness creation strategies and increasing coverage of ANC-4 and above will be important interventions to reduce self-referral practice. Keywords: self-referral practice, primary hospital, South Gondar, Ethiopia