Community referral system influencing caregiver health-seeking for childhood pneumonia in Endebess sub-county, Kenya.

Background: Pneumonia is the primary infectious cause of mortality in children under five, with approximately 800 000 deaths annually in low-income settings. In Kenya, pneumonia accounted for 16% of child deaths in 2022. Good treatment outcome relies on efficient referral system and timely hospital access. However, monitoring referral completion remained challenging in Endebess hospitals.

Aim: To assess determinants and key barriers to utilisation of community referral system.

Setting: Seven public hospitals in Endebess sub-County in Kenya.

Methods: This mixed-methods study involved 273 caregivers, 24 health personnel, 40 Community Health Volunteers (CHV's) and 4 Community Health Assistants. Data were collected using questionnaires and interviews. Quantitative analysis used Statistical Package for Social Sciences Version 22 (Chi-square, logistic regression; p < 0.05). Qualitative data were analysed using thematic analyses.

Results: Overall, 112 caregivers (41%) were referred. However, only 19 referral forms (17%) were filed at hospitals and 10 children (52.6%) recorded in service delivery logbook. Referral completion was significantly associated with distance to the hospital (p = 0.021), whether a CHV had accompanied the patient (p = 0.002) and household income (p= 0.040). Caregivers with self-help group savings were more likely to visit the hospital within 24 h of referral (p = 0.002, OR [odds ratio] = 3.8, 95% CI [confidence interval] = 1.639-8.813) than those without savings.

Conclusion: Utilising CHV diaries and household registers improves referral completion, highlighting the need for digital integration to strengthen data concordance.

Contribution: This study informed policymakers on strengthening community referrals by emphasising CHV report verification, mentorship on documentation and ensuring referral completion.