Abstract
Severely sick-children presenting at primary healthcare facilities need referral to higher level facilities for better care. Adherence to referrals and quality of care received by those referred could serve as critical steps towards their survival. To describe experiences with severely sick children referred to higher-level health facilities for care and reasons for non-adherence to referral; to explore healthcare provider's perspectives to referral. Referrals among 3046 young children were followed for adherence. Assessment of children referred from a PHC facility adhering to referral advice and reasons for non-adherence to referral was determined. Agreement on reported diagnoses at PHC centres and health-facilities receiving patients was assessed. Perspectives of healthcare providers were assessed. 212 children were referred from PHC centres to various hospitals with 14.2% non-adherence. Reasons given: 48.3% of carers adhering felt child's condition was severe; 43.3% complied with healthcare provider directive. The main reasons for non-adherence to referral were no money for transport (50%) and child condition not serious (30.0%). 69.0% of anaemia cases diagnosed at PHC facilities and hospitals. 65.7% fever diagnosed at a PHC centres were confirmed as malaria at the hospitals. Healthcare providers referred patients for severity, perceivedcomplication and non-response to treatment. Adherence was generally good. The level of agreement in diagnosis of common diseases such as malaria and anaemia at PHC centres and district hospitals was high and low for rarer diseases. Capacity should be provided at PHC levels for adequate management of cases presented to reduce referrals carers have to make. This study did not receive funding from any external sources.
Highlights
Capacity should be provided at PHC levels for adequate management of cases presented to reduce referrals carers have to make
The cohort of 3046 children had a total of 12,873 contacts with the 32 PHC centres identified during the period of follow-up, suggesting that on average, each child was taken to a PHC 4-5 times during the period of the study
Adherence to referrals made from PHC centres to district hospitals is quite high and can be further improved through targeted approaches
Summary
6.5 million children in developing countries die every year before reaching their fifth birthday, with a significant proportion of deaths occurring during the first year of life.[1, 2] More than half of these deaths are due to preventable or -treatable diseases.[3, 4] Majority of these deaths could be prevented at PrimaryHealthcare (PHC) facilities that appropriately treat or refer patients to level of care.[5]Whilst every ill-child require prompt, appropriate medical attention,[2,6,7,8] most PHC facilities are constrained in managing illnesses.[9,10,11] Presenting illness in resource-limited and under-capacity PHC facilities for management require children being referred to higher-level facilities.Some carers of such children do not always comply with referrals[11,12] Examples of limited resources include lack of laboratory buildings, laboratory equipment and supplies and under-capacity include lack of qualified personnel. Healthcare (PHC) facilities that appropriately treat or refer patients to level of care.[5]. Whilst every ill-child require prompt, appropriate medical attention,[2,6,7,8] most PHC facilities are constrained in managing illnesses.[9,10,11] Presenting illness in resource-limited and under-capacity PHC facilities for management require children being referred to higher-level facilities Some carers of such children do not always comply with referrals[11,12] Examples of limited resources include lack of laboratory buildings, laboratory equipment and supplies and under-capacity include lack of qualified personnel
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