Referral Pattern Of Patients Received At The National Referral Hospital: Challenges In Low Income Countries

Abstract

Objective: To examine the medical referral pattern of patients received at the Muhimbili National Hospital (MNH) in order to inform the process of strengthening the referral system. Methods: The study design was a prospective study conducted at MNH during a 10-week study period from January to March 2004. The study sample consisted of patients referred to MNH Results: Of the 11,412 patients seen, 72.5% were self-referrals. More than 70% of the patients seen required admission, though not necessarily at tertiary level. Only 0.8% came from outside the Dar es Salaam region. More than 70% of the patients seen required admission. Surgical services were required by 66.8% of patients, with obstetric conditions being most prominent (24.6% of all patients). For those who were formally referred from other health services, lack of expertise and equipment were the most common reasons given for referral (96.3%). Conclusion: Efforts to improve referral systems in low-income countries require that the primary and secondary level hospitals services be strengthened and increased so as to limit inappropriate use of national referral hospitals.

Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey

“…District hospitals should be capable of providing basic surgical procedures [8], but lack of resources and of qualified staff are main deterrents for those in need, unless they can afford to self-refer to tertiary hospitals. A prospective study of the referral system in Dar es Salaam, Tanzania, for example, found that over 70% of over 11,000 patients seen at the National Referral Hospital were self-referrals having bypassed the district hospital and 67% of these were for surgical problems [14]. In this study, lack of expertise at district hospitals was cited in 96% of the cases as the reason for referral to a higher level-hospital.…”

Improving Standards of Care in Obstructed Labour: A Criteria-Based Audit at a Referral Hospital in a Low-Resource Setting in Tanzania

“…Similarly, Kidanto et al [37] recommended a decision-to-delivery interval of two hours for eclampsia patients who required resuscitation to prevent surgical complications, including control of seizures and blood pressure levels before CS. Since the majority of women delivered at MNH are either public or referred patients [47], some presented with complications of obstructed labour on admission, including foetal distress, impending or ruptured uterus, and chrorioamnionitis (MNH Obstetric database 2014, unpublished report). Our timeline of intervention criterion had to be relatively stringent in order to promptly care for public and referral cases that would otherwise face the risk of delayed access to care and thereby increased danger of severe morbidity.…”

Breech delivery at a University Hospital in Tanzania

“…Recently, district hospitals in the region have been upgraded, resulting in fewer deliveries at MNH [14]. At MNH, the CD rate has increased, from 16 % in 1999 [15] to 49 % in 2011 [16].…”