Management of referred labour cases from the metro public hospitals to Komfo Anokye Teaching – Hospital: a case of Kumasi Metropolis

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Maternal deaths have been of major concern to Kumasi Metropolis, Ashanti region and Ghana as a whole. Referrals of maternal cases, labour cases inclusive are one of the contributory factors. The handling of referrals of labour cases by both the referring end (MPHs) an1i the receiving end had not been satisfactory. This had allegedly led to substantial number of deaths which is always registered at the receiving end (KATH). The necessity to address such problems leading to maternal deaths including tie referrals of labour cases in the Metropolis led to the establishment of the MMI-IT. One would like to know the structures put in place by the MMHT and the performance of the MPHs and KATH as far as effective referrals of labour cases are concerned. The study sought to find out the structures/procedures put in place by the Metro Maternal Health Team (MMHT) to ensure effective referrals as far as labour cases are c9ncerned, the promptness of referrals, whether referral notes and partograph accompanied the referred cases from the MPHs (specifically Manhyia, Kumasi South, Suntreso hospitals) to KATH and the promptness of attendance to the referred cases as well as the provision of feedback by KATH. The study made use of three categories of samples comprising, the doctors of CATH labour ward/theatre, nurses/midwives of the labour wards of the MPHs, as well as the clients who were referred from the MPHs to KATH within the period of study. The study was cross sectional, explorative and descriptive in nature with an overall sample size of 73. Questionnaire, structured interview guide as well as participatory observation were the tools for data collection. The findings were that theoretically procedures/structures have been put in place by the MMHT as regards the referral of labour cases, but practically most were not effective. Referrals by the MPHs left much to be desired. The MPHs generally referred a most 30 minutes after recognising a problem, did not always accompany their referred eases with referral notes and partograph, and did not most of the time give all the required information about the referred case. Kumasi South hospital however, performed creditably well in all the areas with at least 90% of their cases being referred in less than 5 minutes, being accompanied by referral notes and partograph as well as giving all information on the referred cases The reverse was true for Manhyia hospital On the other hand, KATH did not provide feedback at all on the referred labour cases from the MPHs but however attended to the cases within 5-10 minutes of arrival. The time is an improvement of what was alleged to be. The study indicated that, there was the need for the MMNT to investigate why their structures regarding the use of referral notes especially of the ones designed by the MMHT, specification of all information about a case, and the use of partograph are not1 effectively and efficiently working and to immediately institute solutions to the findings. As regards the use of the referral notes designed by the MMHT, specification of all information about a referred labour case, and the use of partograph, the in-charges should ensure that there is daily monitoring and supervision and are held accountable for any lapses. Moreover, the MMHT should also investigate to ascertain why the partograph is not mostly used and to organise monthly refresher courses on the use of the partograph for the MPHs if lack of knowledge of its use is the problem. The MPHs representatives on the MMHT: should ensure that information/knowledge/skills received from the monthly meetings are passed on to the others. There should be inspection of log books on the activities on monthly basis to that effect. Also, KATH should appoint a senior medical officer on each team on duty to oversee the provision of feedback.
A thesis submitted to the Department of Community Health, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the award of Master of Science degree in Health Services Planning and Management, 2002