Opuba Everlyne N, Onyango Patrick O, Owenga Jane A
Division of Vaccines and Immunisation, Ministry of Health, Trans-Nzoia County, Nairobi, Kenya.
School of Physical and Biological Sciences, Maseno University, Kisumu, Kenya.
J Public Health Afr. 2025 May 14;16(1):801. doi: 10.4102/jphia.v16i1.801. eCollection 2025.
Pneumonia is the primary infectious cause of mortality in children under five, with approximately 800 000 deaths annually in low-income settings. In Kenya, pneumonia accounted for 16% of child deaths in 2022. Good treatment outcome relies on efficient referral system and timely hospital access. However, monitoring referral completion remained challenging in Endebess hospitals.
To assess determinants and key barriers to utilisation of community referral system.
Seven public hospitals in Endebess sub-County in Kenya.
This mixed-methods study involved 273 caregivers, 24 health personnel, 40 Community Health Volunteers (CHV's) and 4 Community Health Assistants. Data were collected using questionnaires and interviews. Quantitative analysis used Statistical Package for Social Sciences Version 22 (Chi-square, logistic regression; < 0.05). Qualitative data were analysed using thematic analyses.
Overall, 112 caregivers (41%) were referred. However, only 19 referral forms (17%) were filed at hospitals and 10 children (52.6%) recorded in service delivery logbook. Referral completion was significantly associated with distance to the hospital ( = 0.021), whether a CHV had accompanied the patient ( = 0.002) and household income (= 0.040). Caregivers with self-help group savings were more likely to visit the hospital within 24 h of referral ( = 0.002, OR [odds ratio] = 3.8, 95% CI [confidence interval] = 1.639-8.813) than those without savings.
Utilising CHV diaries and household registers improves referral completion, highlighting the need for digital integration to strengthen data concordance.
This study informed policymakers on strengthening community referrals by emphasising CHV report verification, mentorship on documentation and ensuring referral completion.
肺炎是五岁以下儿童死亡的主要感染原因，在低收入地区每年约有80万儿童死亡。在肯尼亚，2022年肺炎导致的儿童死亡占比达16%。良好的治疗效果依赖高效的转诊系统和及时的医院就医机会。然而，在恩代贝斯医院，监测转诊完成情况仍然具有挑战性。
评估社区转诊系统使用的决定因素和主要障碍。
肯尼亚恩代贝斯县的七家公立医院。
这项混合方法研究涉及273名护理人员、24名卫生人员、40名社区卫生志愿者（CHV）和4名社区卫生助理。通过问卷调查和访谈收集数据。定量分析使用社会科学统计软件包第22版（卡方检验、逻辑回归；P<0.05）。定性数据采用主题分析法进行分析。
总体而言，112名护理人员（41%）被转诊。然而，只有19份转诊表格（17%）在医院存档，10名儿童（52.6%）记录在服务提供日志中。转诊完成情况与到医院的距离（P=0.021）、CHV是否陪同患者（P=0.002）以及家庭收入（P=0.040）显著相关。有自助小组储蓄的护理人员比没有储蓄的护理人员更有可能在转诊后24小时内前往医院（P=0.002，比值比[OR]=3.8，95%置信区间[CI]=1.639 - 8.813）。
利用CHV日志和家庭登记簿可提高转诊完成率，凸显了数字整合以加强数据一致性的必要性。
本研究通过强调CHV报告核查、文件记录指导以及确保转诊完成，为政策制定者加强社区转诊提供了参考。
