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Published on: January 19, 2024
Relationship between distance of referring facilities and haemoglobin change in children in Malawi
Elizabeth M Keating1,2, Jeff A Robison1, Msandeni Chiume2
1Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Insights
Childhood anaemia in sub-Saharan Africa is a major concern. This study found that while distance did not impact haemoglobin levels during transfer, facilities farther from Kamuzu Central Hospital had higher child mortality rates.
Area of Science:
- Pediatric Hematology
- Public Health
- Health Services Research
Background:
- Anaemia is a leading cause of child mortality in sub-Saharan Africa.
- Access to blood transfusions is limited, often only at referral hospitals.
- Understanding referral patterns is crucial for improving child survival rates.
Purpose of the Study:
- To investigate the correlation between transfer distance and changes in hemoglobin (Hb) levels in children.
- To assess the impact of distance on mortality rates for anaemic children referred to Kamuzu Central Hospital (KCH) in Malawi.
Main Methods:
- Retrospective cohort study of 2259 children referred to KCH.
- Hb levels measured at referring facilities and KCH.
- Geospatial analysis using ArcGIS and statistical analysis using SAS for Hb change and distance correlation.
Main Results:
- 87.0% of children maintained their anemia category (Hb <4, 4-6, or >6 g/dL) during transfer.
- No significant relationship was found between transfer distance and Hb drop or Hb level at KCH.
- Mortality rates were significantly higher in facilities located 10-50 km from KCH compared to those <10 km away.
Conclusions:
- Referral facilities appear to transfer anaemic children promptly enough to prevent significant Hb decline.
- Despite adequate transfer times, factors influencing the decision to transfer anaemic children require further investigation.
- Geographic distance, while not affecting Hb levels, is associated with increased mortality, highlighting systemic issues in care access.
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.
