Exploring the factors leading to tiered referrals of pregnant women until tertiary healthcare facilities: An in-depth analysis.

Abstract

Introduction: Maternal mortality in Indonesia remains a significant health issue, with a mortality rate of 305 per 100,000 live births, the highest in Southeast Asia. Prolonged referral processes and delays in receiving medical assistance are major factors contributing to the high maternal mortality rate.

Objective: This study aims to explore the factors influencing tiered referrals of pregnant women to tertiary healthcare facilities.

Materials and methods: This descriptive analytical study uses secondary data from medical records of patients admitted to the Obstetrics and Gynecology Maternity Room at Dr. Soetomo Hospital, Surabaya, from July to September 2023, with ethical clearance number 2813/104/4/III/2024. Sampling was done using the total sampling method, with the dependent variable being the referral source (hospital and non-hospital) and independent variables including the number of Antenatal Care (ANC) visits, BMI, gravidity, residence, occupation, and education. Data analysis was performed using multiple logistic regression with SPSS Software.

Results: Among the 280 patients studied, the majority were referred from hospitals (196 patients), and most had abnormal BMI (193 patients). Logistic regression analysis showed that women from rural areas had significantly higher delays in referrals compared to urban residents (p=0.004), while other variables such as age, number of ANC visits, BMI, gravidity, occupation, and education did not show significant influence.

Conclusion: Place of origin is a critical factor influencing referral outcomes, highlighting the significant role of geographical and socio-economic determinants in the accessibility and quality of maternal healthcare services. This study underscores the necessity of an effective and timely referral system to mitigate maternal mortality rates in Indonesia, particularly emphasizing the need for enhanced referral infrastructure in rural areas to ensure prompt access to maternal care and ultimately reduce maternal mortality.

Summary: Indonesia's maternal mortality rate remains high (305 per 100,000 live births), influenced by prolonged referral processes. Secondary data from 280 medical records at Dr. Soetomo General Hospital, Surabaya (July- September 2023), revealed that most patients were referred from hospitals (196), predominantly exhibiting abnormal BMI (193). Logistic regression analysis identified residential location (rural vs. urban) as significantly impacting referral outcomes (p=0.004), whereas other factors (age, ANC visits, BMI, gravidity, occupation, education) showed no significant influence. These findings highlight the critical role of geographic and socioeconomic conditions in maternal healthcare accessibility and emphasise the importance of an efficient and timely referral system to reduce maternal mortality in Indonesia.