Qualitative study on maternal referrals in rural Tanzania: Decision making and acceptance of referral advice
), David P Urassa(2), Elisabeth Darj(3), Anders Carlstedt(4), Pia Olsson(5),
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Corresponding Author
Abstract
The aim of this study was to describe perceptions of maternal referrals in a rural district in Tanzania. Focus group discussions (FGDs) with health workers and community members, stratified by age and gender, were conducted. The FGDs revealed that husbands and relatives are the decision makers in maternal referrals, whereas the women had limited influence, especially on emergency referrals. The process in deciding to seek referral care is envisaged within community perception of seriousness of the condition, difficulty to access and cost involved in transport, living expenses at the hospital, and perceived quality of care at facility level. The hospitals were seen as providing acceptable quality of care, whereas, the health centres had lower quality than expected.
To improve maternal referral compliance and reduce perinatal and maternal morbidity and mortality, community views of existing referral guidelines, poverty reduction, women’s empowerment and male involvement in maternal care are necessary. (Afr J Reprod Health 2008; 12[2]:120-131)
RÉSUMÉEtude qualitative sur l´orientation des sujets recherchant les soins maternels auprès des spécialistes en Tanzanie rurale: Prise de décision et acceptation des conseils des spécialistes. Cette étude avait pour but de décrire les perceptions des orientations des sujets recherchant les soins maternels dans un district rural en Tanzanie. Nous avons mené dix discussions à groupe cible (DGC) avec le personnel médical et les membres de la communauté stratifiés selon l´ âge et le genre. Les DGCs ont révélé que les maris et les parents sont responsables de la prise de décision quand il s´agit des orientations vers les spécialistes alors que les femmes ont une influence limitée, surtout quand il s´agit des orientations auprès des spécialistes d´ urgence. Le processus de décider de demander une orientation auprès du spécialiste est envisagé dans le cadre de la perception de la communauté de la gravité de la condition, la difficulté de trouver le transport et le frais de transport, la dépense quotidienne à l´ hôpital et la qualité perçue de soin au niveau de l´établissement. On considérait que les hôpitaux assuraient des soins de qualité acceptable alors que les centres de soins disposaient d´une qualité inférieure. Pour améliorer la conformité aux orientations des sujets recherchant les soins maternels auprès des spécialistss et pour réduire la morbidité et la mortalité périnatale et maternelle, il faut avoir les opinions de la communauté sur les directives concernant les orientations vers les spécialistes, la réduction de la pauvreté, l´émancipation de la femme et l´ implication de l´ homme dans les soins maternels. (Rev Afr Santé Reprod 2008; 12[2]:120-131)
KEY WORDS: maternal referrals, decision making, rural, Tanzania, FGD
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