Determinants of Self Referals Among Pregnant Women Seeking Delivery Services at Coast General Teaching and Referals Hospital Mombasa, Kenya

Abstract

The World Health organization (WHO) listed six system of health such as; health workforce, health records, governance and leadership, delivery of service and medicine that is accessible, vaccines and technologies and health financing. This study was anchored on service delivery pillar, which is a key pillar of health system across the world. The study sought to establish the predictors influencing pregnant women to refer themselves to CGTRH for delivery services. Determinants to be established included; individual, risk factor, access and institutional determinants. Study sample was 376 respondents and the sample size was reached through employing systemic sampling method. Every pregnant mother seeking maternal care services at the referral facility during the period of the study and established the criteria for inclusion was included in the investigation until the required size of sample was arrived at. In order to get specific sample size, formula of Yamane was used since all subjects possessed the required characteristics. The researcher obtained ethical approval from Kenya Methodist University College. Research permit to conduct the study was obtained from NACOSTI. Authorization for data collection was also obtained from Coast General Teaching & referral Hospital administration. A descriptive cross sectional research design was adopted. Data was collected using structured questionnaire which was administered to the pregnant women seeking delivery services at CGTRH on exit. The data collected was cleaned and coded; quantified and analyzed quantitatively using Windows statistical software SPSSv23. The outcome revealed that women who are pregnant sought CGTRH due to its 24 hour period of operation (p < 0.05; CI = 0.242 to 0.982; 95%; OR = 0.487) were twice expected to seek CGTRH for services of deliver. A 0.05 significance level was registered by regressing multiple variables, additionally revealing that CGTRH period of operation had considerably influenced pregnant women self- referral to CGTRH for delivery services. The results indicated that pregnant women with tertiary education [OR = 4.211; 95% CI = 1.469 to 12.072; p < 0.05] were 4.2 times expected to directly seek services of delivery from the Coast General Teaching & referral Hospital, by passing lower-level healthcare facilities. The study established that risk factors and institutional factors had no significant relationship with self-referrals among expectant women seeking to deliver within CGTRH. The study also established that education level of pregnant women and opening of CGTRH for 24 hours in a day had considerable influence in relation to expectant women seeking to deliver at the referral facility. Therefore, the study concludes that education level and the 24 hour period of operation at CGTRH are significant predictor of expectant women influence in referring themselves while seeking delivery services at CGTRH. The study recommends the health department at the county of Mombasa need to establish mechanisms of making sure that facilities offering primary health to expectant women are operating at 24 hours so as to be attractive to more expectant women pursuing delivery care at the health institution hence reducing the number of expectant women going to CGTRH to pursue delivery services.