Results
Table 1 presents descriptive statistics for the baseline sample of 225 women referred from 20 RHFs to the two districts hospitals, CB Dunbar (75.1%) and Phebe (24.8%). Of the 225, 93 (41.3%) women had complete records and 132 (58.6%) women had records only from the hospital. The most common reasons for referrals were obstructed labor (33.3%), other (12%) which included premature rupture of membranes, anemia, and previous CS (8%). Most women delivered via spontaneous vaginal delivery (56.8%), with 18 women (8%) and 92 babies (40.8%) experiencing complications. On average, women took 23 hours to get to the hospital, after the referral was initiated at the RHF, with the median being 5.8 hours and only 12.9% of the women arriving at the hospital within two hours of less.
Endline data included 287 women with 159 (55.4%) complete records (Table 2 ). Of the total sample, 155 (54%) women were referred to CB Dunbar and 132 (46%) referred to Phebe. Similar to the baseline sample, the most common reasons for referral among the endline sample were obstructed labor (22.6%), previous CS (15.6%), and other (12.8%). Less than half of the women delivered via spontaneous vaginal delivery (41.4%), with 13 women (4.5%) and 67 babies (23.3%) experiencing complications. The average time it took for women to arrive at the district hospital following referral from the RHF was 32 hours, with the median of 7.2 hours and 18 (11.3%) women arriving at the hospital in 2 hours or less from time of referral.
Table 3 shows the association between timepoints, mode of delivery, maternal outcome, newborn outcome, and transfer time. The unadjusted model showed that women at endline were more likely to undergo a CS (OR: 1.86; 95%CI: 0.99-3.46) compared to women at baseline. There was no statistically significant association between timepoints and maternal outcomes. Newborns at endline were significantly less likely to be depressed (OR: 0.31; 95%CI: 0.14-0.68) compared to newborns at baseline. Lastly, there was no statistical significance in transfer time from RHF to hospital between baseline and endline.