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.