Abstract:
Introduction: Referral guidelines are meant to ensure coordination and continuity across all
levels of healthcare. Poor adherence to these guidelines could result in increased morbidity and
mortality among the patients who are denied access; especially in the resource constrained
healthcare settings in developing economies.
Aim: To determine adherence to the national healthcare referral guidelines and immediate
outcomes of children seen at a tertiary teaching hospital in Western Kenya.
Materials and methods: A Cross-sectional study conducted at the Pediatric emergency
department of Moi Teaching and Referral Hospital in Western Kenya between February to June
2016. A total of 422 children aged below 15 years were recruited systematically.
Sociodemographic and clinical data were collected using interviewer administered
questionnaires and clinical chart reviews respectively. Checklists were used to collect
information from ambulances. Pearson chi-square tests and odds ratios were used to test for
association between predictor and outcome variables using statistical package for social science
(SPSS) version-24.Results: More than half (55.5%) of the 422 children enrolled were male while 51.4% were aged between 5 to 14 years. Hospital referrals accounted for 15.9% (n=67) with the rest being self-
referrals and no counter referrals seen. Adherence to all the four transfer guideline requirements
was observed in 46.3% (n=31) of the 67 hospital referrals. Less than half (46.3%) of the hospital
referrals had their referring facilities calling the receiving facility prior to initiating the referral;
83.6% had a referral document; 64.2% were transferred in ambulances while 68.7% (n=46) were
accompanied by health care workers. Most (88.1%) of the hospital referrals were admitted.
Lower level of parental education (p= 0.025), residing outside the host county (p<0.001) and a
child being older than five years (p = 0.015) were significantly associated with hospital referrals.
Hospital referrals were nearly three times (AOR = 2.932; 95% CI: 2.422 – 3.550; p<0.001) more
likely to be admitted compared to children who were self-referred.
Conclusion: There is low adherence to national healthcare referral guidelines among children
seen at the second largest national hospital in Kenya; with less than half of hospital referrals
transferred as per the transfer process guidelines.
