Bypassing nearby Health Centers for Childbirth Services and its Associated Factors among Mothers Attending Postnatal Care at the University of Gondar Comprehensive Specialized Hospital, 2018: A Facility-based Cross-sectional Study

Background: In the health care system, bypassing affects both the primary level and higher-level health care institutions. It compromises the quality of care rendering to the clients of lower and higher level health care system by causing an overcrowded.  And overflow of delivering mothers to higher level causes unnecessary workload, overcrowding, shortage of medical supplies, equipment, drugs, and service dalliance in the health facility which may contribute to institutional maternal and neonatal morbidities and mortalities. Moreover, it causes a client to wait a long time, yet the health care providers devoted their time to looking at minor cases which decreases access to the needy clients. Therefore, this study aimed at assessing all these gaps, which are an important indicator of the quality of care in the health system.

Method: Facility based cross-sectional study was conducted from August 1-30/2018.   A systematic random sampling technique was used to select 391 study participants. Data were entered into Epi Info version-7 and exported to SPSS version 20 for analysis. Logistic regression was computed. Variables whose P-value is < 0.2 in the bi-variable analysis were fitted to the multivariable analysis, and an adjusted odds ratio with their corresponding 95% confidence interval was calculated to determine the statistical association.

Results: 422 mothers were invited to participate in this study out of which 391 mothers respond properly giving a response rate of 96.65%. Overall 246 (62.9%, 95% CI: (58.1, 67.5)) mothers bypassed their catchment health center. Age of the mother, resident, educational status of unable to read and write and primary education, marital status, first time parity, informed where to deliver during ANC follow up and mothers who have no information about the availability of childbirth service at the health center were factors associated with bypassing of nearest health center.

Conclusion: The proportion of women bypassing health centers is high. The individual characteristics that predicted increase in proportion of respondents who bypassed health facilities includes, age, educational and marital status, resident and first time parity. On top of these, information given to the pregnant mother where to deliver and the service availability were found to be important predictor variables; therefore, efforts has to be made with regard to these variables, and a special attention has to be given on information provision by the care provider during ANC care.