Appropriateness of Obstetric Referrals and Associated Factors Among Care Providers in Public Primary Health Care Units of Hadiya Zone, Central Ethiopia Region, Ethiopia: A Facility-Based Cross-Sectional Study

Abstract Background: An effective and appropriate referral system in which care seeking individuals move upward for better care is crucial in a health care system with different levels of facility. If done appropriately and in compliance with the national referral guideline, referrals will significantly affect maternal and perinatal outcomes. However, there is an existing but not well researched gap in the implementation of obstetric referrals in Ethiopia, especially in Hadiya zone. Objective: To assess the appropriateness of obstetric referrals and associated factors among care providers in public primary health care units of Hadiya zone, central Ethiopia region from May 1 to July 30, 2025 Methods: An institution based cross-sectional study was conducted in public primary healthcare units of Hadiya zone. Consecutive sampling technique was employed to select 213 study subjects. The data were gathered using a structured face-to-face interviewer administered questionnaire. Then bivariable logistic regression was carried out and p-value of <0.25 were exported to multivariable logistic regression. AOR at 95% CI and a P-value of less than 0.05 were accepted as statistically significant. Result: In this study a total of 213 obstetric referral care providers and referral paper completeness were assessed with a response rate of 100%. 85(39.7%) at 95% CI [38.2, 41} of the referrals were made appropriately. Standard referral paper being used (35.9%), Pre referral care given (40.8%), referral was accompanied (73.1%), pre referral notification was made (8.5%), and feedback provided (5.1%). Age below 25 (AOR=5.3, 95% CI=2.1, 32), Diploma professional (AOR=16, 95% CI= 2.2, 41), not trained on referral (AOR=4.4, 95% CI=1.3, 14.4), poor knowledge on referral paper component (AOR=3.9, 95% CI=1.2, 12.4,) were strong determinants of inappropriate obstetric referral . Conclusion: Less than half of the care providers made appropriate obstetric referrals. The factors like younger age, educational level of diploma, being not trained on referral and having poor knowledge on the components of referral paper were significantly associated with inappropriate obstetric referral. Therefore, interventions are crucial to improve adherence to the national guideline when referring cases, build the capacity of healthcare providers through training on referral management and deploy appropriate liaison officers