000			03728nam a22003617a 4500
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005			20240305193730.0
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028			_bPhone: +255 28 298 3384
028			_b Fax: +255 28 298 3386
028			_b Email: vc@bugando.ac.tz
028			_b Website: www.bugando.ac.tz
040			_bEnglish _cDLC
041			_aEnglish
100			_a Jackline Suba _945553
222			_aAcute Illness, Appropriateness of Referrals, Outcome, Primary Health Care, Pediatric Primary Care, Referrals
245			_aAppropriateness and Immediate Outcome of Referrals in Pediatric Wards at Bugando Medical Centre, A Tertiary Hospital in North Western Tanzania
260			_aMwanza, Tanzania: _b Tanzania Medical Journal & _b Catholic University of Health and Allied Sciences [CUHAS – Bugando] _c2022/6/15
300			_a Pages 105-117
490			_v Tanzania Medical Journal Volume 33 Issue 3
520			_a Abstract Background: Inappropriate pre-referral care and delays in primary health care facilities contribute to poor patients’ outcomes in secondary and tertiary referral health care facilities. This study was set to determine the proportion, appropriateness and immediate outcome of referrals in paediatrics wards at Bugando Medical Centre (BMC). Methods: A cross-sectional study included reffered children aged 1-59 months in BMC paediatrics wards. The minimum required sample size of 287 was determined by the Taro Yamane scientific formula, we excluded self-referral patients and those who misplaced their referral letters. Referral forms were reviewed, detailed history and thorough physical examination were done. Children were reviewed after 48 hours to determine the immediate outcome. Data were analysed using STATA version 15.1. By logistic regression we determined the association between appropriateness of referrals, clinical factors and outcomes and a p-value < 0.05 was considered to be statistically significant. Results: Out of 602 admissions 55.1% (332/602) were referrals, and total of 300 children were analysed. Only (6) 2% had appropriately completed referral forms and (10) 3.3% were brought in by an ambulance. A total of 133 (44.3%) referrals were categorized as inappropriate. Deaths occurred in 34 (11.3%) [95% CI 8.2% – 15.5%]. Inappropriate referrals were not associated with increased mortality. Presence of lower chest in drawing (OR: 4.9; 95% CI: 1.7 – 13.8; p=0.003), lower limb swelling (OR: 3.6; 95% CI: 1.3 – 10.2; p=0.013), convulsion (OR: 8.1; 95% CI: 2.2 – 29.9; p=0.008), shock (OR: 9.7 95% CI: 1.8 – 52.6; p=0.008), age >2 years (OR: 5.2; 95% CI: 1.7 – 16.2; p=0.004), and inability breastfeed or drink (OR: 7.3; 95% CI: 2.2 – 23.7; p=0.001) were directly associated with mortality in the referred children. Conclusion and recommendations: More than 50% of patients seen are referrals, and 34% of them end up in mortality but inappropriateness of referrals was not directly associated with mortality. The mortality in referred patients is linked to serious illness. Improving the capacity of management of paediatric emergencies in health facilities should go hand in hand with improvement of referral appropriateness in order to improve the overall outcome.
700			_aAdolfine Hokororo _922795
700			_a Tito Chaula _923614
700			_aRogatus Kabyemera _922807
700			_aRespicious Bakalemwa _922767
700			_a Rwezaula Raphael _920565
700			_aElizabeth Kwiyolecha _922964
700			_aNeema Kayange _922515
700			_a Tumaini Mhada _922832
700			_aBenson Kidenya _922050
856			_uhttps://doi.org/10.4314/tmj.v33i3.537
942			_2ddc _cVM
999			_c19512 _d19512