title: Incentives to yield to Obstetric Referrals in deprived areas of Amansie West district in the Ashanti Region, Ghana.
abstract: Obstetric referrals, otherwise known as maternal referrals constitute an eminent component of emergency care, and key to ensuring safe delivery and reducing maternal and child mortalities. The efficiency of Obstetric referral systems is however marred by the lack of accessible transportation and socio-economic disparities in access to healthcare. This study evaluated the role of socio-economic factors, perception and transport availability in honouring Obstetric referrals from remote areas to referral centres.
  
  
  
  This was a cross-sectional study, involving 720 confirmed pregnant women randomly sampled from five (5) sub-districts in the Amansie west district in Ghana, from February to May 2015. Data were collected through structured questionnaire using face-to-face interviewing and analyzed using STATA 11.0 for windows. Logistic regression models were fitted to determine the influence of socio-demographic characteristics and pregnancy history on obstetric referrals.
  
  
  
  About 21.7 % of the women studied honoured referral by a community health worker to the next level of care. Some of the pregnant women however refused referrals to the next level due to lack of money (58 %) and lack of transport (17 %). A higher household wealth quintile increased the odds of being referred and honouring referral as compared to those in the lowest wealth quintile. Women who perceived their disease conditions as emergencies and severe were also more likely to honour obstetric referrals (OR = 2.3; 95 % CI = 1.3, 3.9).
  
  
  
  Clients' perceptions about severity of health condition and low income remain barriers to seeking healthcare and disincentives to honour obstetric referrals in a setting with inequitable access to healthcare. Implementing social interventions could improve the situation and help attain maternal health targets in deprived areas.
authors.affiliation: School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Gladys Buruwaa
authors.initials: GB
authors.lastname: Nuamah
authors.affiliation: School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. agyeibaffour@yahoo.co.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Agyei-Baffour
authors.affiliation: School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Kofi Mensah
authors.initials: KM
authors.lastname: Akohene
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Daniel
authors.initials: D
authors.lastname: Boateng
authors.affiliation: Amansie West District Health Directorate, Ghana Health Service, Manso Nkwanta, Ghana.
authors.forename: Dominic
authors.initials: D
authors.lastname: Dobin
authors.affiliation: Ghana Health Service, Accra, Ghana.
authors.forename: Kwasi
authors.initials: K
authors.lastname: Addai-Donkor
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004630:Emergencies; D004632:Emergency Medical Services; D005260:Female; D005869:Ghana; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D011203:Poverty / Q000706:statistics & numerical data*; D011247:Pregnancy; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014186:Transportation; D055815:Young Adult
keywords: Amansie West; Deprived areas; Ghana; Inequitable access to healthcare; Maternal health; Obstetric referrals