Limitations
This study has several limitations. First, because we extracted referral
data from routinely collected data at the RHFs and district hospitals
through admission logs, additional demographic data such as women’s age,
marital status, education level, and reproductive history that could
have functioned as a confounding factor are lacking. Furthermore,
reasons for referral could not be adjusted for because we could not
collapse the variables in a scientifically meaningful way to include in
the adjusted model. Second, additional time points were not captured to
examine where specifically the delays in travel time occurred. For
example, capturing dispatch time (between call for referral, dispatch
ambulance), response time (dispatch time plus arrival of ambulance on
scene), travel time (depart scene to arrive hospital), prehospital time
(from making referral call to the woman arriving at the hospital) could
have been additional time related variables that could have enhanced the
results (Caviglia et al., 2021). Due to these limitations, the result of
this study needs to be interpreted carefully.