Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
BMJ Open. 2022 Oct 3;12(10):e058778. doi: 10.1136/bmjopen-2021-058778.
In order to prevent overburdening of higher levels of care, national healthcare systems rely on processes of referral, including for refugee populations which number 26 million globally. The goal of this study is to use data from a population-based household survey to describe patterns of referral services among a population of Congolese and Burundian refugees living in Tanzania.
Cross-sectional survey using cluster randomised sampling.
Nyarugusu refugee camp, Kigoma, Tanzania.
153 refugees.
Referral compliance.
Proportion of referrals that were surgical; proportion of referrals requiring diagnostic imaging.
Out of 153 individuals who had been told they needed a referral, 96 (62.7%) had gone to the referral hospital. Of the 57 who had not gone, 36 (63%) reported they were still waiting to go and had waited over a month. Of the participants who had been referred (n=96), almost half of the participants reported they were referred for a surgical problem (n=43, 45%) and the majority received radiological testing at an outside hospital (n=72, 75%). Congolese refugees more frequently had physically completed their referral compared with Burundians (Congolese: n=68, 76.4% vs Burundian: n=28, 43.8%, p<0.001). In terms of intracamp referral networks, most refugees reported being referred to the hospital or clinic by a community health worker (n=133, 86.9%).
To our knowledge, this is the first community-based study on patterns of referral healthcare among refugees in Tanzania and sub-Saharan Africa. Our findings suggest patients were referred for surgical problems and for imaging, however not all referrals were completed in a timely fashion. Future research should attempt to build prospective referral registries that allow for better tracking of patients and examination of waiting times.
为了防止医疗资源过度集中于高级别医疗机构，各国医疗体系都依赖转诊流程，包括为全球数量达 2600 万的难民提供服务。本研究的目的是利用基于人群的家庭调查数据，描述居住在坦桑尼亚的刚果和布隆迪难民人群的转诊服务模式。
采用整群随机抽样的横断面调查。
坦桑尼亚基戈马的尼扬扎鲁古难民营。
153 名难民。
转诊的遵从性。
转诊中手术的比例；需要影像学诊断的转诊比例。
在被告知需要转诊的 153 人中，有 96 人（62.7%）去了转诊医院。在未去的 57 人中，有 36 人（63%）表示仍在等待，已等待一个多月。在已被转诊的 96 人中，近一半的参与者表示他们被转诊为手术问题（n=43，45%），且大多数人在外部医院接受了影像学检查（n=72，75%）。与布隆迪难民相比，刚果难民更频繁地完成了转诊（刚果难民：n=68，76.4%；布隆迪难民：n=28，43.8%，p<0.001）。就营地内转诊网络而言，大多数难民表示是由社区卫生工作者（n=133，86.9%）将他们转诊至医院或诊所。
据我们所知，这是坦桑尼亚和撒哈拉以南非洲首次针对难民转诊医疗服务模式进行的基于社区的研究。我们的研究结果表明，患者被转诊治疗手术问题和进行影像学检查，但并非所有转诊都能及时完成。未来的研究应尝试建立前瞻性转诊登记系统，以更好地跟踪患者并检查等候时间。
