Comparison of maternal and neonatal profiles and outcomes between referred and self-referred patients delivered at the Ganyesa District Hospital
Date
2012-01-11
Authors
Mosedi, Abigail Thumeka
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Abstract
BACKGROUND: Maternal health care in South Africa is based on the District
Health System model which includes public health facilities (such as primary
health care clinics, community health centers and district hospitals) as well as
private health facilities. The majority of uncomplicated deliveries are expected
to happen at community health centers and only complicated cases are
expected to be referred to district hospitals. But in reality, the majority of
deliveries in a health district happen in district hospitals. This often results in
increasing utilisation of resources and decreased quality of care at these
hospitals. The Ganyesa District Hospital, situated in Dr Ruth Segomotsi
Mompati District in the North West Province has been facing similar
challenges. Although the Hospital has been collecting routine information for
the District Health Information System, it has never been analysed
systematically to understand the impact of the current referral system on the
performance of this Hospital.
Aims: To compare maternal and neonatal profiles and outcomes between
referred and self-referred patients delivered at the Ganyesa District Hospital
during one year study period (1st April 2008 to 31st March 2009).
Methodology: The setting of this study was Ganyesa District Hospital, in the
Dr Ruth Segomotsi Mompati District in the North West Province. A Cross
sectional study design was used utilising retrospective data, from the Hospital
information systems. The MS excel software based data extraction tool was
designed to obtain data from Hospital Information System. The variables used
for this study included socio-demographic and clinical profiles of patients. A
comparative statistical analysis were done to compare the profile of two
groups of patients: (Referred and Self-referred)
Results: The majority of the subjects were black. Most of the patients were,
single and unemployed. The majority of the patients were multigravidae. The
most common past and current medical disorders were diabetes and
pregnancy induced hypertension (PIH). The prevalence of pre-term deliveries
of the subjects was 14.8%. The majority of the subjects delivered normally
(86.5%) followed by CS (13.2%). The majority of CSs were performed as emergency. PIH and previous CS were common maternal indications whereas
fetal distress and mal-presentation were common fetal indications. Prolonged
labour and Intra-partum haemorrhage were common maternal complications
whereas fetal distress and fresh still-birth were common fetal complications.
There were 26 (4.3%) post-partum maternal complications. There were 3
(4.6%) deaths during this period among the patients (Maternal mortality rate of
501/ 100,000).
The incidence of low birth weight (less than 2.5 kg) was 23%. The fresh and
macerated stillbirths and low Apgar score were common neonatal
complications.
The majority of the patients (374, 62.5%) arrived after-hours. The majority of
the patients arrived by ambulance (87.3%). The median distance between
places of residence and PHC facilities (Clinic and CHC) was 12 km. The
median distance between places of residence and the Hospital was 45 km.
There were no significant differences in socio-demographic (age, ethnicity,
marital and employment status) and obstetric profiles (gravidity, prevalence of
past medical disorders and antenatal disorders, prevalence of pre-term
deliveries, mode of deliveries, intra-partum or post-partum complications and
maternal outcomes.) between referred and self-referred patients. The two
groups were not significantly different in terms of birth weight, the incidence of
low birth weight, and Apgar scores (at 1 minute and 10 minutes) and neonatal
complications.
More referred patients arrived after hours in comparison to self-referred
patients More referred patients arrived with ambulance in comparison to selfreferred
patients. The self-referred patients stayed closer to health facilities.
This was probably the reason these patients decided to come to Hospital
instead of going to their nearby PHC clinics.
Conclusion: Findings of this study will be reported to the district and
provincial department of health and hopefully will be used for improvement of
maternal health services in the Dr Ruth Segomotsi Mompati District.