Relationship between distance of referring facilities and haemoglobin change in children in Malawi.

Autor: Keating EM; Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.; Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi., Robison JA; Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA., Chiume M; Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi., Taddie M; Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA., VanDerslice JA; Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA., Benson LS; Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA., Fitzgerald E; Division of Pediatric Emergency Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA., Crouse HL; Section of Pediatric Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Tx, USA., Eckerle MD; Division of Pediatric Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA.; Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Ciccone EJ; Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA., Porucznik CA; Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
Jazyk: angličtina
Zdroj: Paediatrics and international child health [Paediatr Int Child Health] 2021 Nov; Vol. 41 (4), pp. 253-261. Date of Electronic Publication: 2022 Mar 01.
DOI: 10.1080/20469047.2022.2044674
Abstrakt: Background: Anaemia is a significant cause of mortality in children in sub-Saharan Africa where blood transfusion is often available only at referral hospitals. Understanding the pattern of referrals by health facilities is essential to identify the delays that affect child survival.
Aim: To determine if there was a correlation between change in haemoglobin (Hb) level and distance from referring facilities to Kamuzu Central Hospital (KCH) in Malawi, and whether distance affected mortality rates.
Methods: This was a retrospective cohort study of 2259 children referred to KCH whose Hb was measured at the referring facility or at KCH. Maps were created using ArcGIS® software. The relationship between distance from KCH and change in Hb was assessed by χ 2 analysis and multiple linear regression with SAS© software.
Results: The majority of children were referred by health facilities in the Lilongwe District. When categorised as Hb <4, 4-6 or >6 g/dL, 87.0% of children remained in the same category during transfer. There was no significant relationship between Hb drop and distance from KCH. Distance from KCH was not a significant predictor of Hb level at KCH or Hb change. However, mortality rates were significantly higher in facilities that were 10-50 km from KCH than in those which were <10 km away.
Conclusions: Using distance as a proxy for time, this suggests that referring facilities are transferring children sufficiently quickly to avert significant reductions in Hb. Despite this, there is a need to identify the factors that influence the decision to transfer anaemic children.
Databáze: MEDLINE
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