Community referral system influencing caregiver health-seeking for childhood pneumonia in Endebess sub-county, Kenya.

BACKGROUND

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.

AIM

To assess determinants and key barriers to utilisation of community referral system.

SETTING

Seven public hospitals in Endebess sub-County in Kenya.

METHODS

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.

RESULTS

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.

CONCLUSION

Utilising CHV diaries and household registers improves referral completion, highlighting the need for digital integration to strengthen data concordance.

CONTRIBUTION

This study informed policymakers on strengthening community referrals by emphasising CHV report verification, mentorship on documentation and ensuring referral completion.