Why first-level health workers fail to follow guidelines for managing severe disease in children in the Coast Region, the United Republic of Tanzania
Nicholas D Walter, Thomas Lyimo, Jacek Skarbinski, Emmy Metta, Elizeus Kahigwa, Brendan Flannery, Scott F Dowell, Salim Abdulla & S Patrick Kachur
Volume 87, Number 2, February 2009, 99-107
Table 4. Univariate analysis of factors associated with referral among children located in community follow-up (n = 166), the United Republic of Tanzania, 2006
| Factors | Referred | Not referred | OR | 95% CI | P-value | |||
|---|---|---|---|---|---|---|---|---|
| n = 28 |
n = 138 |
|||||||
| n | % | n | % | |||||
| Female | 10 | 36 | 57 | 41 | 0.8 | 0.3–1.8 | 0.5 | |
| Less than 2 months | 1 | 4 | 4 | 3 | 1.4 | 0.2–13.4 | 0.8 | |
| IMCI danger signs | ||||||||
| Vomiting everything | 6 | 38 | 34 | 40 | 0.9 | 0.3–2.4 | 0.8 | |
| Convulsions | 4 | 25 | 23 | 27 | 0.9 | 0.3–2.8 | 0.8 | |
| Lethargic or unconsciousa | 11 | 69 | 25 | 29 | 5.7 | 2.1–15 | 0.002 | |
| Not eating | 1 | 6 | 10 | 12 | 0.5 | 0.1–4.0 | 0.5 | |
| HMIS diagnosis | ||||||||
| Severe malaria only | 24 | 86 | 98 | 72 | 2.4 | 1.1–5.4 | 0.03 | |
| Severe pneumonia only | 1 | 4 | 18 | 13 | 4.0 | < 0.1–2.1 | 0.2 | |
| Both severe malaria and severe pneumonia | 1 | 4 | 15 | 11 | 0.4 | < 0.1–2.8 | 0.3 | |
| Anaemiaa | 20 | 71 | 3 | 2 | 113 | 27–463 | < 0.0001 | |
| SES-related factors | ||||||||
| SES index in the poorest third | 12 | 43 | 44 | 32 | 1.6 | 0.7–3.4 | 0.2 | |
| Parent registered for a community health fund | 5 | 19 | 11 | 8 | 2.1 | 0.5–10 | 0.3 | |
| Setting | ||||||||
| Seen at a government health facility | 26 | 93 | 125 | 91 | 1.3 | 0.1–12.8 | 0.8 | |
| Seen at a dispensary | 14 | 50 | 55 | 40 | 1.4 | 0.5–4.0 | 0.5 | |
CI, confidence interval; HMIS, Health Management Information System; IMCI, integrated management of childhood illness; OR, odds ratio; SES, socioeconomic status.
a Association significant in multivariate analysis.