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BMC International Health and Human Rights

, 2:4

First Online: 30 April 2002Received: 06 December 2001Accepted: 30 April 2002DOI: 10.1186-1472-698X-2-4

Cite this article as: Font, F., Quinto, L., Masanja, H. et al. BMC Int Health Hum Rights 2002 2: 4. doi:10.1186-1472-698X-2-4

Abstract

BackgroundReferral is a critical part of appropriate primary care and of the Integrated Management of Childhood Illness IMCI strategy. We set out to study referrals from the aspect both of primary level facilities and the referral hospital in Kilombero District, southern Tanzania. Through record review and a separate prospective study we estimate referral rates, report on delays in reaching referral care and summarise the appropriateness of pediatric referral cases in terms of admission to the pediatric ward at a district hospital

MethodsA sample of patient records from primary level government health facilities throughout 1993 were summarised by age, diagnosis, whether a new case or a reattendance, and whether or not they were referred. From August 1994 to July 1995, mothers or carers of all sick children less than five years old attending the Maternal and Child Health MCH clinic or outpatient department OPD of SFDDH were interviewed using a standard questionnaire recording age, sex, diagnosis, place of residence, whether the child was admitted to the paediatric ward, and whether the child was referred.

ResultsFrom record review, only 0.6% of children from primary level government facilities were referred to a higher level of care. At the referral hospital, 7.8 cases per thousand under five catchment population had been referred annually. The hospital MCH clinic and OPD were generally used by children who lived nearby: 91% n = 7,166 of sick children and 75% n = 607 of admissions came from within 10 km. Of 235 referred children, the majority 62% had come from dispensaries. Almost half of the referrals 48% took 2 or more days to arrive at the hospital. Severe malaria and anaemia were the leading diagnoses in referred children, together accounting for a total of 70% of all the referrals. Most referred children 167-235, 71% were admitted to the hospital paediatric ward.

ConclusionsThe high admission rate among referrals suggests that the decision to refer is generally appropriate, but the low referral rate suggests that too few children are referred. Our findings suggest that the IMCI strategy may need to be adapted in sparsely-populated areas with limited transport, so that more children may be managed at peripheral level and fewer children need referral.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-698X-2-4 contains supplementary material, which is available to authorized users.

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Autor: Fidel Font - Llorens Quinto - Honoraty Masanja - Rose Nathan - Carlos Ascaso - Clara Menendez - Marcel Tanner - Joanna Arm

Fuente: https://link.springer.com/







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