The Role of Referring Centres in the Tragedy of ‘Unbooked' Patients

Abstract

Context : Despite the proliferation of health centres in Nigeria, the number of ‘unbooked' obstetric patients seen in tertiary institutions remains high, and their obstetric outcome is usually poor. Since many of these patients are referred from these health centres, it is important to determine their contributions to the tragedy of these patients. Objectives : To assess the contribution of referring centres to the morbidity and mortality seen in unbooked patients. Study Design and Setting : Cross-sectional study at a University Teaching Hospital in Ilesa, Nigeria. Subjects and Methods : All unbooked patients admitted into the obstetric wards of the Wesley Guild Hospital, Ilesa between January and July 2000 had a proforma completed to record information on age, parity, social class, source of referral, the management given at the source of referral and the condition of the patient on admission. Results : Of the 148 unbooked patients admitted during the study period, 87 (58.8%) received care in various referring centres. Sixty-five of these 87 patients (74.7%) were mismanaged. The sources of referral were traditional birth attendants (TBA), mission houses and private hospitals where 100%, 87.5% and 80% respectively of the patients were mismanaged before being allowed to come to the hospital. Among referred patients, 62.1% were received in poor clinical condition compared to 39.3% of those who did not receive prior care anywhere. (P Conclusion : Inadequate care at sources of referral is a major contributor to morbidity and mortality in unbooked patients. We suggest that these health facilities be supervised and monitored to reduce the current high morbidity and mortality among unbooked patients. (Tropical Journal of Obstetrics and Gynaecology, 2001, 18(1): 24-26)