Utilisation of referral services by high risk pregnant population in rural Varanasi
Swain, S.; Prakash, A.
Indian Journal of Maternal and Child Health Official Publication of Indian Maternal and Child Health Association 3(3): 74-76
1992
ISSN/ISBN: 0970-8928 PMID: 12288814 Document Number: 334957
Poor utilization of maternal-child health care is an important cause of high perinatal and maternal mortality and morbidity in rural areas of India. The study was conducted in the Cholapur Primary Health Center area, about 35 km from the Banaras Hindu University Hospital and about 30 km from the District Hospital, Varanasi, which institutions are the main centers of referral in this locality. Cholapur block is connected to the hospitals by road. 9 subcenters were selected at random for the study, each subcenter serving a population of about 5000. The antenatal registers maintained at the subcenters were analyzed and high-risk pregnant referrals were personally interviewed. The study period lasted for 1 year from July 1988. The records pertained to 1047 pregnant women, of these, 466 (44.50%) who registered for antenatal care at the subcenters were high-risk cases. Out of these 466 high-risk cases, 167 cases were referred: 82 (49%) to the primary health care (PHC), 56 (33.5%) to the district hospital, and 29 (17.3%) to the medical college hospital. Grand multigravida status in 57 cases (34.13%) and bad obstetric history in 41 cases (24.56%) were the main risk factors for referral. Only 15 (9%) cases out of the 167 cases took advantage of the referral services: 5 (33.3%) were seen by the doctors at PHC, 7 (46.6%) at the district hospital, and 3 (20%) at the medical college hospital. Those women who did not benefit from the referral services stated financial exigency to be the major factor for nonuse of the referral services (34.2%). In rural areas, screening can be done by health workers after considering age, parity, previous obstetric history, nutritional parameters (such as height, weight, and hemoglobin status), abdominal examination findings (fundal height, suspicion of big or small baby, twins, and malpresentations). The health worker should refer these high-risk cases to the nearest physician or the primary health center.