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Published in: Malaria Journal 1/2017

Open Access 01-12-2017 | Research

Referral of children seeking care at private health facilities in Uganda

Authors: Anthony K. Mbonye, Esther Buregyeya, Elizeus Rutebemberwa, Siân E. Clarke, Sham Lal, Kristian S. Hansen, Pascal Magnussen, Philip LaRussa

Published in: Malaria Journal | Issue 1/2017

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Abstract

Background

In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health facilities in order to explore ways of improving treatment and referral of sick children in this sector.

Methods

A survey was conducted from August to October 2014 in Mukono district, central Uganda. Data was collected using a structured questionnaire supplemented by Focus Group Discussions and Key Informant interviews with private providers and community members.

Results

A total of 241 private health facilities were surveyed; 170 (70.5%) were registered drug shops, 59 (24.5%) private clinics and 12 (5.0%) pharmacies. Overall, 104/241 (43.2%) of the private health facilities reported that they had referred sick children to higher levels of care in the two weeks prior to the survey. The main constraints to follow referral advice as perceived by caretakers were: not appreciating the importance of referral, gender-related decision-making and negotiations at household level, poor quality of care at referral facilities, inadequate finances at household level; while the perception that referral leads to loss of prestige and profit was a major constraint to private providers.

Conclusion

In conclusion, the results show that referral of sick children at private health facilities faces many challenges at provider, caretaker, household and community levels. Thus, interventions to address constraints to referral of sick children are urgently needed.
Literature
1.
go back to reference Uganda Bureaux of Statistics. Uganda Population and Housing census. Kampala. 2014. Uganda Bureaux of Statistics. Uganda Population and Housing census. Kampala. 2014.
2.
go back to reference Uganda Bureaux of Statistics. Uganda Demographic and health Survey. Kampala. 2011. Uganda Bureaux of Statistics. Uganda Demographic and health Survey. Kampala. 2011.
3.
go back to reference Achan J, Tibenderana J, Kyabayinze D, Mawejje H, Mugizi R, Mpeka B, et al. Case management of severe malaria–a forgotten practice: experiences from health facilities in Uganda. PLoS ONE. 2011;6:e17053.CrossRefPubMedPubMedCentral Achan J, Tibenderana J, Kyabayinze D, Mawejje H, Mugizi R, Mpeka B, et al. Case management of severe malaria–a forgotten practice: experiences from health facilities in Uganda. PLoS ONE. 2011;6:e17053.CrossRefPubMedPubMedCentral
4.
go back to reference Font F, Quinto L, Masanja H, Nathan R, Ascaso C, Menendez C, et al. Paediatric referrals in rural Tanzania: the Kilombero District Study—a case series. BMC Int Health Hum Rights. 2002;2:4.CrossRefPubMedPubMedCentral Font F, Quinto L, Masanja H, Nathan R, Ascaso C, Menendez C, et al. Paediatric referrals in rural Tanzania: the Kilombero District Study—a case series. BMC Int Health Hum Rights. 2002;2:4.CrossRefPubMedPubMedCentral
5.
go back to reference Oryema-Lalobo M. Community health seeking practices for the management of malaria of the under-five in Bugiri District, Uganda. East Afr J Public Health. 2009;6:191–6.PubMed Oryema-Lalobo M. Community health seeking practices for the management of malaria of the under-five in Bugiri District, Uganda. East Afr J Public Health. 2009;6:191–6.PubMed
6.
go back to reference Källander K, Tomson G, Nsungwa-Sabiiti J, Senyonjo Y, Pariyo G, Peterson S. Community referral in home management of malaria in western Uganda: a case series study. BMC Int Health Hum Rights. 2006;6:2.CrossRefPubMedPubMedCentral Källander K, Tomson G, Nsungwa-Sabiiti J, Senyonjo Y, Pariyo G, Peterson S. Community referral in home management of malaria in western Uganda: a case series study. BMC Int Health Hum Rights. 2006;6:2.CrossRefPubMedPubMedCentral
7.
go back to reference Peterson S, Nsungwa-Sabiiti J, Were W, Nsabagasani X, Magumba G, Nambooze J, et al. Coping with paediatric referral–Ugandan parents’ experience. Lancet. 2004;363:1955–6.CrossRefPubMed Peterson S, Nsungwa-Sabiiti J, Were W, Nsabagasani X, Magumba G, Nambooze J, et al. Coping with paediatric referral–Ugandan parents’ experience. Lancet. 2004;363:1955–6.CrossRefPubMed
8.
go back to reference Samuelsen H, Tersbøl BP, Mbuyita SS. Do health systems delay the treatment of poor children? A qualitative study of child deaths in rural Tanzania. BMC Health Serv Res. 2013;13:67.CrossRefPubMedPubMedCentral Samuelsen H, Tersbøl BP, Mbuyita SS. Do health systems delay the treatment of poor children? A qualitative study of child deaths in rural Tanzania. BMC Health Serv Res. 2013;13:67.CrossRefPubMedPubMedCentral
9.
go back to reference Mbonye AK. Prevalence of childhood illnesses and care-seeking practices in rural Uganda. Scientific World J. 2003;3:721–30.CrossRef Mbonye AK. Prevalence of childhood illnesses and care-seeking practices in rural Uganda. Scientific World J. 2003;3:721–30.CrossRef
10.
go back to reference Sserwanga A, Sears D, Kapella BK, et al. Anti-malarial prescription practices among children admitted to six public hospitals in Uganda from 2011 to 2013. Malar J. 2015;14:331.CrossRefPubMedPubMedCentral Sserwanga A, Sears D, Kapella BK, et al. Anti-malarial prescription practices among children admitted to six public hospitals in Uganda from 2011 to 2013. Malar J. 2015;14:331.CrossRefPubMedPubMedCentral
11.
go back to reference Mbonye AK, Lal S, Cundill B, Hansen KS, Clarke S, Magnussen P. Treatment of fevers prior to introducing rapid diagnostic tests for malaria in registered drug shops in Uganda. Malar J. 2013;12:131.CrossRefPubMedPubMedCentral Mbonye AK, Lal S, Cundill B, Hansen KS, Clarke S, Magnussen P. Treatment of fevers prior to introducing rapid diagnostic tests for malaria in registered drug shops in Uganda. Malar J. 2013;12:131.CrossRefPubMedPubMedCentral
12.
go back to reference Källander K, Hildenwall H, Waiswa P, Galiwango E, Peterson S, Pariyo G. Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study. Bull World Health Organ. 2008;86:332–8.CrossRefPubMedPubMedCentral Källander K, Hildenwall H, Waiswa P, Galiwango E, Peterson S, Pariyo G. Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study. Bull World Health Organ. 2008;86:332–8.CrossRefPubMedPubMedCentral
13.
go back to reference Font F, Quinto L, Masanja H, Nathan R, Ascaso C, Menendez C, et al. Paediatric referrals in rural Tanzania: the Kilombero District Study—a case series. BMC Int Health Hum Rights. 2002;30:4.CrossRef Font F, Quinto L, Masanja H, Nathan R, Ascaso C, Menendez C, et al. Paediatric referrals in rural Tanzania: the Kilombero District Study—a case series. BMC Int Health Hum Rights. 2002;30:4.CrossRef
14.
go back to reference Birungi H, Mugisha F, Nsabagasani X, Okuonzi S, Jeppsson A. The policy on public-private mix in the Ugandan health sector: catching up with reality. Health Policy Plan. 2001;16(Suppl 2):80–7.CrossRefPubMed Birungi H, Mugisha F, Nsabagasani X, Okuonzi S, Jeppsson A. The policy on public-private mix in the Ugandan health sector: catching up with reality. Health Policy Plan. 2001;16(Suppl 2):80–7.CrossRefPubMed
15.
go back to reference Nsungwa-Sabiiti J, Peterson S, Pariyo G, Ogwal-Okeng J, Petzold MG, Tomson G. Home-based management of fever and malaria treatment practices in Uganda. Trans R Soc Trop Med Hyg. 2007;101:1199–207.CrossRefPubMed Nsungwa-Sabiiti J, Peterson S, Pariyo G, Ogwal-Okeng J, Petzold MG, Tomson G. Home-based management of fever and malaria treatment practices in Uganda. Trans R Soc Trop Med Hyg. 2007;101:1199–207.CrossRefPubMed
16.
go back to reference Mbonye AK, Ndyomugyenyi R, Turinde A, Magnussen P, Clarke SE, Chandler C. The feasibility of introducing rapid diagnostic tests for malaria in drug shops in Uganda. Malar J. 2010;9:367.CrossRefPubMedPubMedCentral Mbonye AK, Ndyomugyenyi R, Turinde A, Magnussen P, Clarke SE, Chandler C. The feasibility of introducing rapid diagnostic tests for malaria in drug shops in Uganda. Malar J. 2010;9:367.CrossRefPubMedPubMedCentral
17.
go back to reference Kozuki N, Guenther T, Vaz L, Moran A, Soofi SB, Kayemba CN, et al. A systematic review of community-to-facility neonatal referral completion rates in Africa and Asia. BMC Public Health. 2015;15:989.CrossRefPubMedPubMedCentral Kozuki N, Guenther T, Vaz L, Moran A, Soofi SB, Kayemba CN, et al. A systematic review of community-to-facility neonatal referral completion rates in Africa and Asia. BMC Public Health. 2015;15:989.CrossRefPubMedPubMedCentral
18.
go back to reference van der Geest S. Self-care and the informal sale of drugs in South Cameroon. Soc Sci Med. 1987;25:293–305.CrossRefPubMed van der Geest S. Self-care and the informal sale of drugs in South Cameroon. Soc Sci Med. 1987;25:293–305.CrossRefPubMed
19.
go back to reference Ministry of Health. Health Sector Strategic Plan III. Ministry of Health. Kampala. 2010. Ministry of Health. Health Sector Strategic Plan III. Ministry of Health. Kampala. 2010.
20.
go back to reference Chandler CI, Hall-Clifford R, Asaph T, Pascal M, Clarke S, Mbonye AK. Introducing malaria rapid diagnostic tests at registered private outlets in Uganda: limitations of diagnostic testing in the reality of diagnosis. Soc Sci Med. 2011;72:937–44.CrossRefPubMedPubMedCentral Chandler CI, Hall-Clifford R, Asaph T, Pascal M, Clarke S, Mbonye AK. Introducing malaria rapid diagnostic tests at registered private outlets in Uganda: limitations of diagnostic testing in the reality of diagnosis. Soc Sci Med. 2011;72:937–44.CrossRefPubMedPubMedCentral
21.
go back to reference Hutchinson E. Evaluation of the referral system implemented in registered drug shops in Uganda. Final Evaluation Report. 2012. Hutchinson E. Evaluation of the referral system implemented in registered drug shops in Uganda. Final Evaluation Report. 2012.
22.
go back to reference Hutchinson E, Chandler C, Clarke S, Lal S, Magnussen P, Kayendeke M, et al. ‘It puts life in us and we feel big’: shifts in the local health care system during the introduction of rapid diagnostic tests for malaria into drug shops in Uganda. Crit Public Health. 2015;25:48–62.CrossRefPubMed Hutchinson E, Chandler C, Clarke S, Lal S, Magnussen P, Kayendeke M, et al. ‘It puts life in us and we feel big’: shifts in the local health care system during the introduction of rapid diagnostic tests for malaria into drug shops in Uganda. Crit Public Health. 2015;25:48–62.CrossRefPubMed
23.
go back to reference Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.CrossRefPubMed Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.CrossRefPubMed
Metadata
Title
Referral of children seeking care at private health facilities in Uganda
Authors
Anthony K. Mbonye
Esther Buregyeya
Elizeus Rutebemberwa
Siân E. Clarke
Sham Lal
Kristian S. Hansen
Pascal Magnussen
Philip LaRussa
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Malaria Journal / Issue 1/2017
Electronic ISSN: 1475-2875
DOI
https://doi.org/10.1186/s12936-017-1723-1

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