Reasons and outcome of paediatric referrals from first-level health facilities in Sabongari, Zaria, Northwestern Nigeria.

Background: Referral is a crucial component of primary care and whenappropriately carried out is believed to result in favourable outcomeof illnesses. This study sought to determine the reasons and outcomesof Paediatric (under-five) referrals from first-level healthfacilities, and the factors influencing the outcomes. Methods: Across-sectional descriptive study was carried out in six sampled publicfirst-level health facilities in Sabon Gari Local Government Area ofKaduna State in the Northwest zone of Nigeria. A total of 106under-five children referred during the sixteen-week study period fromthe six sampled health facilities were studied. Structuredquestionnaires and a two-way referral form were designed and used fordata collection and the children followed up to determine the type ofcare received and its outcome. Results: Diarrhoea was the most commonreason for referral (34%) followed by convulsion (10.4%), difficulty inbreathing (8.5%) and surgery (8.5%). The most important reason for thedecision to refer was for better diagnosis and treatment (70.8%). Thereferral compliance rate was 37.8%. Of those that complied, 31 (83.8%)of them recovered, 6 (16.2%) died and none had a disability (P >0.05). Of the 61 (62.2%) of the referrals that did not comply, themajority (65.6%) of them were treated by traditional healers while34.4% were managed at home using home-based remedies. The compliantreferrals were found to significantly have more favourable outcomesthan the non-compliant cases. Factors that influenced the referraloutcomes included compliance, transport difficulty, financialconstraints and husband's consent. Conclusion: Referral to a higherlevel of care where there are better facilities for diagnosis andtreatment generally improve the chances of a favourable outcome.Thereis a need for adequate investment in resources at first-level healthfacilities to make referrals worthwhile and more effective.