Determinasi Faktor Biologis dan Kontekstual Terhadap Keterlambatan Rujukan Maternal Berisiko di Kabupaten Lombok Tengah
DOI:
https://doi.org/10.33394/bioscientist.v13i4.17340Keywords:
Keterlambatan rujukan, maternal, proses administrasi, sistem rujukan, layanan kesehatanAbstract
This study aimed to identify biological and contextual determinants influencing maternal referral delays at Praya Regional Hospital, Central Lombok Regency. Referral delays significantly contributed to increased risks of maternal complications and mortality, particularly in areas with limited access to healthcare services. A quantitative cross-sectional design was used, and the sample included 95 pregnant women referred to Praya Hospital. Data were obtained through a structured questionnaire and analyzed using Chi-Square tests and binary logistic regression to determine associations between variables and to identify the most dominant factor. The analysis showed that administrative barriers had a significant association with referral delays (p = 0.001), while other variables such as trust (p = 0.383), healthcare provider readiness (p = 0.084), and indirect costs (p = 0.005) showed no significant associations. Administrative barriers were identified as the strongest determinant, with an odds ratio (OR) of 8.037 (95% CI: 3.044–21.221; p = 0.000). To accelerate maternal referral processes, simplifying administrative procedures and implementing digital systems such as SISRUTE were strongly recommended. Further studies are recommended to evaluate the effectiveness of technology-based referral system reforms in reducing maternal mortality rates, especially in resource-limited settings.
References
Abu‐Dahab, R., & Sakellariou, D. (2020). Barriers to Accessing Maternal Care in Low Income Countries in Africa: A Systematic Review. International Journal of Environmental Research and Public Health, 17(12), 4292. https://doi.org/10.3390/ijerph17124292
Almalki, S. safran, Alhomiany, A. M., Alsharif, M. Z., ALsolumany, F. J. A., Alnajjar, M. M. abed, Alsharif, M. N. M., Al-Talhi, S. O., Alosaimi, S. M. O., Albaqami, S. M. K., & Alsulaimani, M. A. A. (2024). Transforming Healthcare Through Effective Health Administration Practices: A Systematic Review. Journal of Ecohumanism, 3(7). https://doi.org/10.62754/joe.v3i7.4670
Ameyaw, E. K., Njue, C., Tran, N. T., & Dawson, A. (2020). Quality and Women’s Satisfaction With Maternal Referral Practices in Sub-Saharan African Low and Lower-Middle Income Countries: A Systematic Review. BMC Pregnancy and Childbirth, 20(1). https://doi.org/10.1186/s12884-020-03339-3
Amissah-Arthur, M.-B., Gyaban-Mensah, A., Boima, V., Yorke, E., Dey, D., Ganu, V., & Mate-Kole, C. (2022). Health-seeking behaviour, referral patterns and associated factors among patients with autoimmune rheumatic diseases in Ghana: A cross-sectional mixed method study. PLOS ONE, 17(9), e0271892. https://doi.org/10.1371/journal.pone.0271892
Anggondowati, T., El-Mohandes, A. A. E., Qomariyah, S. N., Kiely, M., Ryon, J. J., Gipson, R. F., Zinner, B., Achadi, A., & Wright, L. L. (2017). Maternal characteristics and obstetrical complications impact neonatal outcomes in Indonesia: a prospective study. BMC Pregnancy and Childbirth, 17(1), 100. https://doi.org/10.1186/s12884-017-1280-1
Banke‐Thomas, A., Balogun, M., Wright, K., Ajayi, B., Abejirinde, I. O., Olaniran, A., Giwa-Ayedun, R. O., Odusanya, B., & Afolabi, B. B. (2020). Reaching Health Facilities in Situations of Emergency: Qualitative Study Capturing Experiences of Pregnant Women in Africa’s Largest Megacity. Reproductive Health, 17(1). https://doi.org/10.1186/s12978-020-00996-7
Benson, A. E., Shatzel, J. J., Ryan, K. S., Hedges, M. A., Martens, K., Aslan, J. E., & Lo, J. O. (2022). The incidence, complications, and treatment of iron deficiency in pregnancy. European Journal of Haematology, 109(6), 633–642. https://doi.org/10.1111/ejh.13870
Binyaruka, P., & Borghi, J. (2022). An equity analysis on the household costs of accessing and utilising maternal and child health care services in Tanzania. Health Economics Review, 12(1), 36. https://doi.org/10.1186/s13561-022-00387-7
Cassol, K., Magni, C., Ribeiro, V. V, Mondelli, M. F. C. G., & Lopes, A. C. (2023). Validation of the Questionnaire “Knowledge, Attitudes and Practices” in Populations of Pregnant Women Exposed to Pesticides. Codas, 35(3). https://doi.org/10.1590/2317-1782/20212021285en
Dalal, S., Nagar, R., Hegde, R., Vaishnav, S., Abdullah, H., & Kasper, J. (2022). Referral Care for High-Risk Pregnant Women in Rural Rajasthan, India: A Qualitative Analysis of Barriers and Facilitators. BMC Pregnancy and Childbirth, 22(1). https://doi.org/10.1186/s12884-022-04601-6
Daniels, A. A., & Abuosi, A. (2020). Improving emergency obstetric referral systems in low and middle income countries: a qualitative study in a tertiary health facility in Ghana. BMC Health Services Research, 20(1), 32. https://doi.org/10.1186/s12913-020-4886-3
Darmayanti, M. M., & Setiawati, E. (2023). Studi Analisis Sistem Rujukan Berdasarkan Determinan Kasus Maternal Di Provinsi Kalimantan Selatan. Jurnal Penelitian Kesehatan (JPK), 21(1), 27–34.
Dorussen, H., Hansen, M. E., Pickering, S. D., Reifler, J., Scotto, T. J., Sunahara, Y., & Yen, D. (2024). The influence of waiting times and sociopolitical variables on public trust in healthcare: A cross-sectional study of the NHS in England. Public Health in Practice, 7, 100484. https://doi.org/10.1016/j.puhip.2024.100484
Geller, S. E., Koch, A. R., Garland, C. E., MacDonald, E. J., Storey, F., & Lawton, B. (2018). A global view of severe maternal morbidity: moving beyond maternal mortality. Reproductive Health, 15(S1), 98. https://doi.org/10.1186/s12978-018-0527-2
Hailemariam, T., Atnafu, A., Gezie, L. D., Kaasbøll, J., Klein, J., & Tilahun, B. (2025). Digitalizing the Community Health Information System Improved Women’s Retention on the Maternal Continuum of Care Pathway in Northwest Ethiopia: A Quasi-Experimental Study. Plos One, 20(3), e0312965. https://doi.org/10.1371/journal.pone.0312965
Heranovita, H., Hardiana, H., & Ferdiyus, F. (2024). Analisis Usability Sistem Rujukan Terpadu (SISRUTE) Rumah Sakit Di Provinsi Aceh Tahun 2024. Innovative: Journal Of Social Science Research, 4(3), 15814–15831.
Hsb, S. M. H., Santosa, H., & Asfriyati, A. (2020). Relationship of Family Income and Family Support With Maternal Reference in Pregnant Women in Pantai Cermin BEmONC, Langkat District, 2019. Budapest International Research and Critics Institute (Birci-Journal) Humanities and Social Sciences, 3(1), 486–493. https://doi.org/10.33258/birci.v3i1.798
Huttunen, J., & Koivisto, T. (2024). Optimizing neurosurgery clinic operations: a comparative study of interventions in Finland’s public healthcare system. International Journal for Quality in Health Care, 36(4). https://doi.org/10.1093/intqhc/mzae106
Indarti, J., Solihin, A., V. Suastika, A., Wardhani, D. P., Ramadhani, M. T., Afdi, Q. F., Syafitri, S. M., Ikhsan, M., & Alda, K. (2021). Three-Delay Model on Maternal Mortality Cases in Tertiary Referral Hospital in Indonesia. EJournal Kedokteran Indonesia, 9(2), 99. https://doi.org/10.23886/ejki.9.60.99
Indriani, D., Damayanti, N. A., Teguh, D., Ardian, M., Suhargono, H., Urbaya, S., Wulandari, R. D., Nindya, T. S., Ernawaty, E., Putri, N. K., & Ridlo, I. A. (2020). The Maternal Referral Mobile Application System for Minimizing the Risk of Childbirth. Journal of Public Health Research, 9(2). https://doi.org/10.4081/jphr.2020.1813
Kabuya, J.-B. B., Mataka, A., Chongo, G., Kamavu, L. K., Chola, P. N., Manyando, C., De Brouwere, V., & Ippolito, M. M. (2020). Impact of maternal death reviews at a rural hospital in Zambia: a mixed methods study. International Journal for Equity in Health, 19(1), 119. https://doi.org/10.1186/s12939-020-01185-5
Khalid, A., Adamjee, R., Sattar, S., & Hoodbhoy, Z. (2022). Maternal and Child Surveillance in Peri-Urban Communities: Perceptions of Women and Community Health Workers From Pakistan. Plos Global Public Health, 2(4), e0000295. https://doi.org/10.1371/journal.pgph.0000295
Kimario, A. A., Mahmoud, A., Thomas, J. A., Mallilah, B. P., Mlay, P., Olomi, G., & Mmbaga, B. T. (2024). Service Availability and Readiness to Provide Maternal and Newborn Healthcare Services in Kilimanjaro Region, Tanzania: A Cross Sectional Study. BMJ Open, 14(12), e086275. https://doi.org/10.1136/bmjopen-2024-086275
Laing, S., Jarmain, S., Elliott, J., Dang, J., Gylfadottir, V., Wierts, K., & Nair, V. (2024). Codesigned Standardised Referral Form: Simplifying the Complexity. BMJ Health & Care Informatics, 31(1), e100926. https://doi.org/10.1136/bmjhci-2023-100926
Law, T. J., Stephens, D., & Wright, J. G. (2022). Surgical wait times and socioeconomic status in a public healthcare system: a retrospective analysis. BMC Health Services Research, 22(1), 579. https://doi.org/10.1186/s12913-022-07976-6
Mahmood, M. A., Hendarto, H., Laksana, M. A. C., Damayanti, H. E., Suhargono, M. H., Pranadyan, R., Santoso, K. H., Redjeki, K. S., Winard, B., Prasetyo, B., Vercruyssen, J., Moss, J. R., Bi, P., Masitah, S., Warsiti, Pratama, A. W., Dewi, E. R., Listiyani, C. H., & Mufidah, I. (2021). Health system and quality of care factors contributing to maternal deaths in East Java, Indonesia. PLOS ONE, 16(2), e0247911. https://doi.org/10.1371/journal.pone.0247911
Mahmood, T., Rehman, A. U., Tserenpil, G., Siddiqui, F., Ahmed, M., Siraj, F., & Kumar, B. (2019). The Association between Iron-deficiency Anemia and Adverse Pregnancy Outcomes: A Retrospective Report from Pakistan. Cureus. https://doi.org/10.7759/cureus.5854
Majeed, R. A., Yamani, H. F., AlSharif, M. H., Sindi, S. S., Aljohani, R. Y., Kalkatawi, H. M., Alqiri, A. T., Hawsawi, H. S., Alabdali, M. H., & Noori, A. A. (2024). The Impact of Health Administration on Healthcare Quality: A Systematic Review of Effective Management Practices. Journal of Ecohumanism, 3(7), 2909–2917. https://doi.org/10.62754/joe.v3i7.4687
Makanyanga, T. B., Madzima, B., Mungati, M., Chadambuka, A., Gombe, N. T., Juru, T., Umeokonkwo, C. D., & Tshimanga, M. (2024). Maternal Death Surveillance and Response System Evaluation in Makonde District, Zimbabwe, 2021. Plos One, 19(7), e0301929. https://doi.org/10.1371/journal.pone.0301929
Mengist, B., Semahegn, A., Yibabie, S., Amsalu, B., & Tura, A. K. (2024). Barriers to Proper Maternal Referral System in Selected Health Facilities in Eastern Ethiopia: A Qualitative Study. BMC Health Services Research, 24(1). https://doi.org/10.1186/s12913-024-10825-3
Nabulo, H., Gottfreðsdóttir, H., Ngonzi, J., & Kaye, D. K. (2023). Experiences of Referral With an Obstetric Emergency: Voices of Women Admitted at Mbarara Regional Referral Hospital, South Western Uganda. BMC Pregnancy and Childbirth, 23(1). https://doi.org/10.1186/s12884-023-05795-z
Nishimwe, C., Mchunu, G., & Mukamusoni, D. (2021). Community‐ Based Maternal and Newborn Interventions in Africa: Systematic Review. Journal of Clinical Nursing, 30(17–18), 2514–2539. https://doi.org/10.1111/jocn.15737
Pratama, A. I., Ekasari, F., & Yanti, D. E. (2022). Analisis Program Pelayanan Obstetri Neonatal Emergency Komprehensif (PONEK). Media Informasi, 18(2), 93–103. https://doi.org/10.37160/bmi.v18i2.54
Rudiyanti, N. (2024). Determinants of Delays in Seeking Care in Maternal Referrals in Indonesia (Ecological Studies). JKM (Jurnal Kebidanan Malahayati), 10(2), 157–165. https://doi.org/10.33024/jkm.v10i2.14094
Rudiyanti, N., & Utomo, B. (2024). Challenges of health workers in primary health facilities in implementing obstetric emergency referrals to save women from death in Indonesia: A qualitative study. Belitung Nursing Journal, 10(6), 644–653. https://doi.org/10.33546/bnj.3525
Sanga, A., Kibusi, S., & Kengia, J. T. (2025). The effectiveness of community engagement using M-Mama champions in improving awareness of obstetric danger signs, birth preparedness and complication readiness among pregnant women in Bahi, Dodoma: A cluster randomized pragmatic implementation trial. PLOS Global Public Health, 5(4), e0004315. https://doi.org/10.1371/journal.pgph.0004315
Selemani, S., Mwakyusa, M. O., Bashiri, S., Ezekiel, M. J., Mwakawanga, D. L., Al‐beity, F. M. A., & Pembe, A. B. (2024). “Are All Referrals Necessary?” Experiences and Perceptions of Maternity Healthcare Providers on Emergency Intrapartum Referrals in Dar Es Salaam, Tanzania. Plos One, 19(2), e0298103. https://doi.org/10.1371/journal.pone.0298103
Starr, S., Kim, W. C., Oke, R., Carvalho, M., Ledesma, Y., Okullu, S., Ariokot, M. G., Wange, A. H., Agwang, E., Ekuchu, P., Boeck, M., Juillard, C., Ajiko, M. M., & Dicker, R. A. (2022). The Third Delay in General Surgical Care in a Regional Referral Hospital in Soroti, Uganda. World Journal of Surgery, 46(9), 2075–2084. https://doi.org/10.1007/s00268-022-06591-0
Susiloningtyas, L. (2020). Sistem Rujukan Dalam Sistem Pelayanan Kesehatan Maternal Perinatal di Indonesia. Jurnal Ilmiah Pamenang, 2(1), 6–16.
Teka, H., Yemane, A., Berhe Zelelow, Y., Tadesse, H., & Hagos, H. (2022). Maternal near-miss and mortality in a teaching hospital in Tigray region, Northern Ethiopia. Women’s Health, 18. https://doi.org/10.1177/17455057221078739
Udenigwe, O., Okonofua, F., Ntoimo, L., & Yaya, S. (2023). Seeking Maternal Health Care in Rural Nigeria: Through the Lens of Negofeminism. Reproductive Health, 20(1). https://doi.org/10.1186/s12978-023-01647-3
Verma, A., Choudhary, R., Chaudhary, R., & Kashyap, M. (2023). Maternal Near-Miss and Maternal Mortality in a Tertiary Care Center of Western Uttar Pradesh: A Retrospective Study. Cureus. https://doi.org/10.7759/cureus.42697
Wahyudi, E. S., Arso, S. P., & Wigati, P. A. (2023). Dinamika Penggunaan Sistem Rujukan Terintegrasi (SISRUTE) di Puskesmas Kota Tangerang Selatan. Jurnal Manajemen Kesehatan Indonesia, 11(2), 155–165.
Wondmeneh, T. G. (2022). Dietary Diversity Practice and Its Influencing Factors Among Pregnant Women in Afar Region of Ethiopia: Mixed Method Study. BMC Pregnancy and Childbirth, 22(1). https://doi.org/10.1186/s12884-022-04641-y
Wulandari, A. R. C., Rachmawaty, R., Ilkafah, I., & Erfina, E. (2021). Patient satisfaction towards healthcare quality in Indonesian Public Hospital. Enfermería Clínica, 31, S745–S750. https://doi.org/10.1016/j.enfcli.2021.09.006
Yaqin, A., Moch Jazil, Prasiska, D. I., & Fatah, N. A. (2023). Maternal Death Determinant and Health Service Delivery During Covid-19: What’s The Difference.? Jurnal Berkala Epidemiologi, 11(3), 224–230. https://doi.org/10.20473/jbe.V11I32023.224-230
Yushida, Y., Cut Nurhasanah, & Nurdahliana. (2022). Determinant Factors Related to the Successful Smooth Delivery Process in the West Aceh District. Science Midwifery, 10(4), 3041–3046. https://doi.org/10.35335/midwifery.v10i4.757
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