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. 2022 Jan 27:41:76.
doi: 10.11604/pamj.2022.41.76.32559. eCollection 2022.

Patterns of referral for refugees in western Tanzania: a retrospective review

Orit Abrahim  1 , Sarah Rapaport  1 , Hilary Ngude  2 , Mohamed Abbas  2 , Peter J Winch  3 , Kent A Stevens  1 , Zachary Obinna Enumah  1   3
Affiliations

Patterns of referral for refugees in western Tanzania: a retrospective review

Orit Abrahim et al. Pan Afr Med J. .

Abstract

Introduction: access to essential secondary and tertiary healthcare, including surgery and medical sub-specialties, is a challenge in low-and-middle income countries (LMICs), especially for displaced populations. Referrals from refugee camps are highly regulated and may pose barriers to accessing essential secondary healthcare in a timely manner. Refugee referral systems and the ways they interact with national systems are poorly understood. Such information is necessary for resource allocation and prioritization, optimizing patient outcomes, national-level planning, and investment in capacity-building.

Methods: a retrospective review of referrals from Nyarugusu Refugee Camp in Tanzania to Kabanga Hospital between January 2016-May 2017 was conducted. Data was collected from logbooks on patient demographics, diagnosis, and reason for referral. Diagnoses and reasons for referral were further coded by organ system and specific referral codes, respectively.

Results: there were 751 entries in the referral logbook between January 2016 and May 2017. Of these, 79 (10.5%) were excluded as they were caretakers or missing both diagnoses and reason for referral resulting in 672 (89.5%) total entries for analysis.The most common organ system of diagnosis was musculoskeletal (171, 25.5%) followed by head, ear, eye, nose and throat (n=164, 24.4%) and infectious disease (n=92, 13.7%). The most common reason for referral was imaging (n=250, 37.2%) followed by need for a specialist (n=214, 31.9%) and further management (n=116, 17.3%). X-ray comprised the majority of imaging referred (n=249, 99.6%). The most common specialties referred to were ophthalmology (n=104, 48.6%) followed by surgery (n=63, 29.4%), and otolaryngology (ENT) (n=17, 7.9%).

Conclusion: given a large burden of referral for refugee patients and sharing of in and out-of-camp healthcare facilities with nationals, refugees should be included in national health care plans and have clear referral processes. Epidemiological data that include these intertwined referral patterns are necessary to promote efficient resource allocation, reduce unnecessary referrals, and prevent delays in care that could affect patient outcomes. International agencies, NGOs, and governments should conduct cost analyses to explore innovative capacity-building projects for secondary care in camp-based facilities.

Keywords: Refugee health; Tanzania; referral; surgery.

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Figures

Figure 1
Figure 1
distribution of reasons for referral
Figure 2
Figure 2
percent distribution of reason for referral by diagnostic category *Neuro= Neurology; HEENT= Head, Eyes, Ears, Nose, Throat; CV= Cardiovascular; Pulm= Pulmonary; GI= Gastrointestinal; ID= Infectious Disease; Endo=Endocrine; MSK= Musculoskeletal
Figure 3
Figure 3
percent distribution of reason for referral by diagnostic category (Con't) *GYN= Gynecologic; NEO= Neoplasm; NEO-U= Neoplasm-Unspecified; UNSP= Unspecified; HEME= Hematology; STM= Soft Tissue Mass; Uro= Urology
See this image and copyright information in PMC

References

    1. Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet. 2015 Aug 8;386(9993):569–624. - PubMed
    1. UNHCR UNHCR’s Principles and Guidance for Referral Health Care for Refugees and Other Persons of Concern. 2009. Accessed 9 May 2020.
    1. UNHCR Public Health Services Survey - Inclusion of Refugees into National Health Systems. 2009. Accessed 9 May 2020.
    1. Assi R, Özger-İlhan S, İlhan MN. Health needs and access to health care: the case of Syrian refugees in Turkey. Public Health. 2019;172:146–152. - PubMed
    1. Bouchghoul H, Hornez E, Duval-Arnould X, Henri-Jean Philippe, Jacky Nizard. Humanitarian obstetric care for refugees of the Syrian war the first 6 months of experience of Gynécologie Sans Frontières in Zaatari Refugee Camp (Jordan) Acta Obstet Gynecol Scand. 2015 Jul;94(7):755–759. - PubMed