Referral Patterns of Children Seeking Out-Patient Neurology Service at the Komfo Anokye Teaching Hospital in the Middle of a Pandemic

Abstract

Background
 The Paediatric Neurology Clinic at Komfo Anokye Teaching Hospital (KATH) was established in 2002 and run twice weekly. It offers management for children with non-surgical neurological and neuro-developmental disorders and has an average attendance of 20 patients (including 5 new cases) a day. In 2019, there were 2050 visits. Following the COVID-19 pandemic in early 2020, measures were instituted to prevent over-crowding at the clinic including a booking system where new patients were given appointment dates. Currently, there is no data on the referral patterns seen at the clinic and how the appointment system has impacted new patients’ attendance. 
 Aim
 To determine the patterns of referrals and time lapse between referrals and first visit for new patients seen at the clinic in 2020.
 Method: 
 A retrospective review of referral notes received at the clinic from January to December 2020 was done to extract data on the age, sex, referring facility, region, referring diagnosis, and the time lapse between referral and first clinic visit. For referrals originating outside KATH, the distance from the referring facility to KATH was estimated using Google Maps. 
 Results
 There were 265 new cases seen at the clinic in 2020. Of these, 172 (64.9%) referral letters were retrieved. The cases included 73 females and 99 males, with median age of 12 months (IQR 5-36). Referrals came from 10 regions with Ashanti contributing 88.4%. There were 136 (79.1%) referrals from public facilities and 36 (20.9%) from private facilities. Eighty-five (49.4%) referrals were from within KATH. Medical officers (72.7%) and pediatricians (7.6%) sent the most referrals. The median time lapse from date of referral to first visit was 16 days (IQR 7-60). The most recuring reasons for referrals were neuro-developmental disorders (41%), seizures (38%) and neuro-behavioral disorders (12%). For referrals originating outside KATH, the median distance from the referring facilities to KATH was 11km (IQR 3.6 – 56).
 Conclusion 
 Children seeking neurological care at KATH are referred from various regions. There are long time lapses between referrals and first visit. It is recommended that referring clinicians in the districts/regions initiate treatment/therapies during this waiting period to minimize neuro-disabilities.