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.

中文翻译：

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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

摘要

背景

贫血是撒哈拉以南非洲儿童死亡的一个重要原因，那里的输血通常只能在转诊医院进行。了解卫生机构的转诊模式对于确定影响儿童生存的延误至关重要。

目的

旨在确定血红蛋白 (Hb) 水平的变化与马拉维卡穆祖中心医院 (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，纳入了 2259 名转诊至 KCH 的儿童，其 Hb 在转诊机构或 KCH 进行了测量。地图是使用 ArcGIS® 软件创建的。^{使用 SAS© 软件通过χ2}分析和多元线性回归评估距 KCH 的距离与 Hb 变化之间的关系。

结果

大多数儿童是由利隆圭地区的卫生机构转诊的。当 Hb <4、4-6 或 >6 g/dL 分类时，87.0% 的儿童在转移期间仍属于同一类别。Hb 下降与距 KCH 的距离没有显着关系。与 KCH 的距离并不是 KCH 时 Hb 水平或 Hb 变化的显着预测因子。然而，距离 KCH 10-50 公里的设施的死亡率明显高于距离 <10 公里的设施。

结论

使用距离作为时间的代表，这表明转诊设施正在足够快地转移儿童，以避免血红蛋白显着下降。尽管如此，仍需要确定影响贫血儿童转院决定的因素。