Rucha Kenneth KibaaraPeter KithukaJohn Francis MugishaMwebaza, Muluya Kharim2021-10-122021-10-122021http://ir-library.ku.ac.ke/handle/123456789/22746A Thesis Submitted in Fulfillment of the Requirement for the Award of Degree of Doctor of Philosophy (Health Management) in the School of Public Health and Applied Human Sciences of Kenyatta University, June, 2021Uganda has a reproductive health situation characterized by delayed community maternal referrals; and yet timely referral to skilled care is essential for pregnant mothers who are at high-risk, to have immediate access to appropriate health care. This has led to few safe deliveries at health centres (52 percent in east – central region compared to 74 percent nationally). Maternal mortality ratio (MMR) at 346 per 100,000 live births and neonatal mortality rate (NMR) at 27 per 1,000 live births respectively in east – central Uganda is high compared to 211 per 100,000 live births and 20 per 1,000 live births respectively globally. This study aimed at training expectant mothers and boda-boda riders on innovation, communication and technology, fleet management, the roles of the different stakeholders and the prevention and management of emergencies. This enabled the establishment of the effect of training of boda-boda riders and expectant mothers in community-based referrals on maternal outcome. This study used a non randomized control trial study design of community intervention. Four sub-counties were selected in the intervention and 4 in the control arms respectively. The study population consisted of 503 pregnant mothers in their third trimester and 192 boda-boda riders randomly and conveniently sampled respectively. Self administered questionnaires, in-depth and key informant interviews, focus group discussions, and secondary records were used to collect both quantitative and qualitative data. Descriptive and inferential data analysis methods using STATA version 14 was conducted for quantitative data. Thematic analysis was done using Ti 7 software atlas. Findings revealed that 70.5% of mothers used boda-boda transport to health centres to deliver, of whom 69.4% were trained boda-boda riders in the intervention arm. Only 51.2% of mothers used boda-boda transport in the control arm. Socio-demographic characteristics of mothers; age (25 – 34 years OR=17.581, p=0.001 and 35 – 44 years OR=247.660, p=0.000), religion (Protestants OR=0.122, p=0.013 and Moslems OR=0.197, p=0.050) and means of transport used by mothers (Motorcycle OR=5.132, p=0.001 and Walking OR=35.732, p=0.000) influenced the maternal outcome. Only age and ownership of motorcycles for the boda-boda riders influenced maternal outcome (25 – 34 years OR=11.351, p=0.000; Personal ownership OR=3.549, p=0.002 respectively). Also, attitude of mothers on comfort of boda-boda transport influenced the maternal outcome (OR=8.352, p=0.011). Communication systems, that is, possession of phones by mothers (OR=4.200, p=0.000) and time interval boda-boda rider took to respond when contacted (21 – 30 minutes OR=0.124, p=0.002 and 31 – 60 minutes OR= 0.003, p=0.000) had effect on the maternal outcome. Lastly, knowledge attained during training by boda-boda riders on fleet management and referral systems had effect on maternal outcome (OR=1.202, p=0.022). For mothers, knowledge attained on the roles of stakeholders and fleet management and referral systems had effect on maternal outcome (OR=2.290, p=0.011 and OR=0.117, p=0.009 respectively). In conclusion, increase in knowledge of mothers and boda-boda riders, system of communication, attitude of mothers and socio-demographic characteristics increased supervised deliveries and have demonstrated its potential in addressing the challenges associated with community referral needs in rural settings. This adds credence to the need for rolling out of training of mothers and boda-boda riders to a greater geographical area. It will also be useful to policy makers whose efforts are geared towards increasing health facility-based deliveries to reduce MMR and NMR.enEffectTraining MothersMotorcycle (Boda-Boda) RidersCommunity-Based ReferralsMaternal OutcomeEast – CentralUgandaThesis