title: Qualitative study on maternal referrals in rural Tanzania: decision making and acceptance of referral advice.
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.
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dares Salaam, Tanzania. andreapembe@yahoo.co.uk
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Pembe
authors.forename: David P
authors.initials: DP
authors.lastname: Urassa
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Darj
authors.forename: Anders
authors.initials: A
authors.lastname: Carlsted
authors.forename: Pia
authors.initials: P
authors.lastname: Olsson
mesh_terms: D003376:Counseling; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data*; D012424:Rural Population; D013636:Tanzania; D013997:Time Factors