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

IF 1.4 4区医学 Q3 PEDIATRICS

Paediatrics and International Child Health Pub Date : 2021-11-01 DOI:10.1080/20469047.2022.2044674

Elizabeth M Keating, Jeff A Robison, Msandeni Chiume, Marissa Taddie, James A VanDerslice, L Scott Benson, Elizabeth Fitzgerald, Heather L Crouse, Michelle D Eckerle, Emily J Ciccone, Christina A Porucznik

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引用次数: 0

Abstract

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 χ² 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.

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马拉维儿童转诊设施距离与血红蛋白变化的关系。

背景:贫血是撒哈拉以南非洲儿童死亡的一个重要原因，在那里输血往往只能在转诊医院提供。了解卫生机构转诊的模式对于确定影响儿童生存的延误至关重要。目的:确定血红蛋白(Hb)水平的变化与马拉维Kamuzu中心医院(KCH)转诊设施的距离之间是否存在相关性，以及距离是否影响死亡率。方法:这是一项回顾性队列研究，涉及2259名在转诊机构或KCH测量Hb的儿童。地图使用ArcGIS®软件创建。采用χ2分析和SAS©软件进行多元线性回归分析，评价与KCH距离与Hb变化的关系。结果:大多数儿童是由利隆圭区卫生机构转诊的。当被分类为Hb 6 g/dL时，87.0%的儿童在转移过程中保持在同一类别。Hb下降与离KCH的距离无显著关系。与KCH的距离不是KCH或Hb变化时Hb水平的显著预测因子。然而，在距离KCH 10-50公里的设施中，死亡率明显高于距离KCH 10-50公里的设施。结论:使用距离作为时间的代表，这表明转诊设施足够迅速地转移儿童，以避免Hb的显著减少。尽管如此，仍有必要确定影响转移贫血儿童决定的因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Paediatrics and International Child Health PEDIATRICS-

CiteScore

3.30

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Paediatrics and International Child Health is an international forum for all aspects of paediatrics and child health in developing and low-income countries. The international, peer-reviewed papers cover a wide range of diseases in childhood and examine the social and cultural settings in which they occur. Although the main aim is to enable authors in developing and low-income countries to publish internationally, it also accepts relevant papers from industrialised countries. The journal is a key publication for all with an interest in paediatric health in low-resource settings.