Self-Referrals among Women Seeking Skilled Birth Attendance Services in Selected Public Hospitals in Marsabit County, Kenya
Adoyo, Joseph Onyango
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Self-referral to higher-level health facilities by women in search for skilled birth attendance services shows autonomy of women in the choice of facilities for desired services but can also be a reflection of non-adherence to established referral pathways. The choice has negative effect on delivery of services and human resource within a health care system. The Kenya Health Sector Referral Strategy has provided for a framework for its implementation and further decentralized to county level with an aim to optimizing the utilization and access of facilities at different levels of healthcare system. The study was conducted to explore self-referral, by establishing the extent and determine socio demographic, health system and institutional related factors associated with self-referral among women seeking skilled birth attendance services in Marsabit County. The study adopted a cross-sectional design at two selected referral hospitals. A systematic sampling technique was employed among women at post-natal ward to achieve 161 participants, and data collected using interviewer administered questionnaire. Data was analyzed by use of Chi-square and multiple logistic regression statistics to determine the factors associated with self-referral at 95% confidence interval. The result indicates that 47.2% had self-referred. The odds of self-referral to higher level health facilities were, increased among women; aged 25-30 (AOR 5.174, CI 1.015-26.365, p-value 0.048), referred for other ANC services (AOR 4.057, CI 1.405-11.720, p-value 0.010), who visited the referral facility before for delivery (AOR 5.395, CI 1.411 – 20.628, p-value 0.014), and less likely among women who perceived privacy and confidentiality of services (AOR 0.370, CI 0.138-0.990, p-value 0.048). Out of 10 women seeking skilled birth attendance services, four are self-referrals that signifies a possible implication on an unprecedented increased workload at referral facilities and at the same time increased cost implication on women to access these services. Therefore, targeting to address the factors that influences self-referral practice, there need for creation of awareness campaigns to reach all pregnant women and in particular those aged between 25 and 30 years to change their biased perception towards higher-level hospitals and improving the availability of all recommended ANC services at primary level facilities to reduce self-referral.