Regional Health Bureau, Southern Nations Nationalities and Peoples' Region, Hawassa, Ethiopia
College of Medicine and Health Sciences, School of Public Health, Hawassa University, Hawassa, Sidama, Ethiopia.
BMJ Open. 2021 Jun 10;11(6):e047640. doi: 10.1136/bmjopen-2020-047640.
Ethiopia's primary care has a weak referral system for sick children. We aimed to identify health post and child factors associated with referrals of sick children 0-59 months of age and evaluate the healthcare providers' adherence to referral guidelines.
A cross-sectional facility-based survey.
This study included data from 165 health posts in 52 districts in four Ethiopian regions collected from December 2018 to February 2019. The data included interviews with health extension workers, assessment of health post preparedness, recording of global positioning system (GPS)-coordinates of the health post and the referral health centre, and reviewing registers of sick children treated during the last 3 months at the health posts. We analysed the association between the sick child's characteristics, health post preparedness and distance to the health centre with referral of sick children by multivariable logistic regressions.
Referral to the nearest health centre of sick young infants aged 0-59 days and sick children 2-59 months.
The health extension workers referred 39/229 (17%) of the sick young infants and 78/1123 (7%) of the older children to the next level of care. Only 18 (37%) sick young infants and 22 (50%) 2-59 months children that deserved urgent referral according to guidelines were referred. The leading causes of referral were possible serious bacterial infection and pneumonia. Those being classified as a severe disease were referred more frequently. The availability of basic amenities (adjusted OR, AOR=0.38, 95% CI 0.15 to 0.96), amoxicillin (AOR=0.41, 95% CI 0.19 to 0.88) and rapid diagnostic test (AOR=0.18, 95% CI 0.07 to 0.46) were associated with less referral in the older age group.
Few children with severe illness were referred from health posts to health centres. Improving the health posts' medicine and diagnostic supplies may enhance adherence to referral guidelines and ultimately reduce child mortality.
埃塞俄比亚的初级保健系统中，基层医疗机构的转诊制度对患病儿童而言较为薄弱。本研究旨在明确与 0-59 月龄患病儿童转诊相关的卫生所及儿童因素，并评估医疗服务提供者对转诊指南的遵循情况。
一项基于医疗机构的横断面调查。
本研究数据来自于 2018 年 12 月至 2019 年 2 月期间在埃塞俄比亚四个地区的 52 个区的 165 个卫生所，研究内容包括对健康促进员进行访谈、评估卫生所的准备情况、记录卫生所和转诊保健中心的全球定位系统（GPS）坐标，以及查阅卫生所最近 3 个月内接受治疗的患病儿童登记册。我们采用多变量逻辑回归分析了患病儿童特征、卫生所准备情况和与卫生中心的距离与患病儿童转诊之间的关系。
健康促进员将 229 名 0-59 日龄患病婴儿中的 39 名（17%）和 1123 名 2-59 月龄患病儿童中的 78 名（7%）转诊至下一级医疗机构。仅有 18 名（37%）应根据指南紧急转诊的 0-59 日龄患病婴儿和 22 名（50%）2-59 月龄患病儿童被转诊。转诊的主要原因是可能存在严重细菌感染和肺炎。被归类为严重疾病的患儿更常被转诊。基本设施的配备情况（调整后的比值比，OR=0.38，95%置信区间，CI 0.15-0.96）、阿莫西林（OR=0.41，95%CI 0.19-0.88）和快速诊断检测（OR=0.18，95%CI 0.07-0.46）与较大年龄组中较少的转诊相关。
很少有重病患儿从卫生所转诊至保健中心。改善卫生所的药物和诊断用品供应可能会增强对转诊指南的遵循，最终降低儿童死亡率。
