Maternal versus child health
Coping with paediatric referral: Ugandan parents’ experience
Poverty is the main barrier to completing hospital referral for children in Uganda
Authors:
J. Nsungwa-Sabiiti; S. Peterson; W. Were; X. Nsabagasani; G. Magumba; J. Nambooze; G. Mukasa
Publisher:
The Lancet, 2004
This article, published in The Lancet, reports on a study examining the constraints faced by caretakers in completing referrals of severely ill children to hospital in Uganda. The study found that only 28 per cent of children had completed referral after two weeks, and at an average cost of US$8.85. Failure to attend hospital resulted mainly from lack of money (90 per cent of cases), transport problems (26 per cent) and responsibilities at home (17 per cent). Some children with incomplete referral continued treatment at referring health centres, or in the private sector, where facilities were generally inadequate to meet their needs.
The authors conclude that poverty is the main reason why referral is not completed for many sick children. They call for efforts to improve hospital care which include a reduction of patients’ costs. In addition, they recommend a series of improvements that could be made at the current level of funding. These include: consistent use of referral letters, prioritising of referred patients, polite reception by health staff, and implementation of bicycle ambulances. Lastly, the authors recommend the use of more specific Integrated Management of Childhood Illness (IMCI) referral criteria when referral is difficult, and the empowerment of first-level health workers to manage severely ill children. [adapted from author]
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