Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 6;21(1):927.
doi: 10.1186/s12913-021-06945-9.

Critical comparative analysis of data sources toward understanding referral during pregnancy and childbirth: three perspectives from Nigeria

Emma Radovich #  1 , Aduragbemi Banke-Thomas #  2 , Oona M R Campbell  3 , Michael Ezeanochie  4 , Uchenna Gwacham-Anisiobi  5 , Adedapo B A Ande  4 , Lenka Benova  3   6
Affiliations

Critical comparative analysis of data sources toward understanding referral during pregnancy and childbirth: three perspectives from Nigeria

Emma Radovich et al. BMC Health Serv Res. .

Abstract

Background: The highest risk of maternal and perinatal deaths occurs during and shortly after childbirth and is preventable if functional referral systems enable women to reach appropriate health services when obstetric complications occur. Rising numbers of deliveries in health facilities, including in high mortality settings like Nigeria, require formalised coordination across the health system to ensure that women and newborns get to the right level of care, at the right time. This study describes and critically assesses the extent to which referral and its components can be captured using three different data sources from Nigeria, examining issues of data quality, validity, and usefulness for improving and monitoring obstetric care systems.

Methods: The study included three data sources on referral for childbirth care in Nigeria: a nationally representative household survey, patient records from multiple facilities in a state, and patient records from the apex referral facility in a city. We conducted descriptive analyses of the extent to which referral status and components were captured across the three sources. We also iteratively developed a visual conceptual framework to guide our critical comparative analysis.

Results: We found large differences in the proportion of women referred, and this reflected the different denominators and timings of the referral in each data source. Between 16 and 34% of referrals in the three sources originated in government hospitals, and lateral referrals (origin and destination facility of the same level) were observed in all three data sources. We found large gaps in the coverage of key components of referral as well as data gaps where this information was not routinely captured in facility-based sources.

Conclusions: Our analyses illustrated different perspectives from the national- to facility-level in the capture of the extent and components of obstetric referral. By triangulating across multiple data sources, we revealed the strengths and gaps within each approach in building a more complete picture of obstetric referral. We see our visual framework as assisting further research efforts to ensure all referral pathways are captured in order to better monitor and improve referral systems for women and newborns.

Keywords: Data; Emergency obstetric care; Facility-based birth; Health systems; Household survey; Maternal health; Medical records; Newborn health; Nigeria; Referral.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual framework of obstetric referral pathways
Fig. 2
Fig. 2
From NDHS 2018, flowchart of origin to destination facility types among women who reported being referred during labour/childbirth (n = 208)
See this image and copyright information in PMC

References

    1. WHO, UNICEF, UNFPA, World Bank Group, UNDP . Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations population division [internet] Geneva: World Health Organization; 2019. pp. 1–119.
    1. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323–e333. doi: 10.1016/S2214-109X(14)70227-X. - DOI - PubMed
    1. Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–1299. doi: 10.1016/S0140-6736(06)69381-1. - DOI - PubMed
    1. Paxton A, Maine D, Freedman L. The evidence for emergency obstetric care. Int J Gynaecol Obstet. 2005;88(2):181–193. doi: 10.1016/j.ijgo.2004.11.026. - DOI - PubMed
    1. WHO, UNFPA, UNICEF . International Confederation of Midwives, International Confederation of Nurses, International Federation of Gynecology and Obstetrics, et al. definition of skilled health personnel providing care during childbirth [internet] Geneva: World Health Organization; 2018.

LinkOut - more resources