Ahmed Amdihun Essa Dawud Muhammed Ahmed


BACkGROUND: Referral is an important component of the hierarchical health care delivery system to ensure that all people receive appropriate care. Weak referral system is identified to be a major reason for the unacceptably high maternal mortality and morbidity in Ethiopia. However, there is limited information on the details of referral system in Ethiopia particularly in emergency obstetrics and gynecological patients.
OBJECTIVE: The objective of this study is to assess the status of referral compliance and referral components of emergency obstetrics and gynecological patients
METHODS: A hospital based cross sectional study was conducted by reviewing the referral letters and patients’ charts of 426 emergency obstetric patients referred to Felege Hiwot Referral Hospital from January 1 to February 30, 2017 G.C.
RESULT: The standard referral letter was used only in 28.2% of the cases. More than two- third (70%) of the referrals were directly from primary health care units to tertiary hospital. The major reason (81.28%) for referral was for better investigation and/or management. Time of referral was included in only 5.2%, priority of the referral in 33.09%, vital signs in 38.7%, basic investigations in 43.2%, and the pre-referral managements in 47.7%. The most neglected component in this study was feedback written for only one case (0.23%).
CONCLUSION: This study showed a high rate of noncompliance; disparity in the components of referral letter and high rate of missing of the vital components of the referral letters. Improving the weak referral system as identified in this study can have strong impact to strengthen the existing hierarchical health care delivery system. This can strongly contribute to advance the delivery of appropriate health care, particularly the reduction of maternal mortality and morbidity.
kEY WORDS: Emergency obstetrics referral, referral system, referral letter (Ethiopian Journal of Reproductive Health; 2019; 11;1:61-70)



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