Abstract:

Classified as self and non-self-referrals, the ideal situation is that patients begin from lower levels of healthcare to higher levels. This improves the utilization of the primary care units, reduces unnecessary congestion of higher levels and makes for efficient healthcare delivery in general. This study aimed to assess the prevalence and predictors of self-referral among patients accessing healthcare in a tertiary hospital in Calabar, Nigeria. Ethical approval and informed consent were obtained. The study adopted quantitative data collection methods. This facility-based, cross-sectional study was carried out among 400 patients aged 18 years and above accessing care in the General Outpatient Clinic of the University of Calabar Teaching Hospital, Calabar in Cross River State. Overall, 191(47.8%) were males while 209(52.3%) were females. The mean age of study participants was 40.5±13.4 years, the most common age group was 31 to 40 years (28.2%). Prevalence of self-referral was 68.3%. Factors significantly associated with self-referral practices were sex (p<0.001), age group (p<0.001), marital status (p<0.001) and occupation (p=0.006). At multivariate regression analysis, females compared with males (OR: 5.299; 95% CI: 3.271 to 8.587), as well as those who were presently unmarried compared with those presently married (OR: 1.920; 95% CI: 1.052 to 3.505) were significantly more likely to practice self-referral. Self-referral practice is common and sex and marital status were identified as predictors. This is more so with unmarried females. Interventions to promote utilization and referral by healthcare providers through the prescribed channel is strongly recommended.

References:

[1] Carter MW, Robbins CL, Gavin L, Moskosky S (2018), Referral Practices Among U.S. Publicly Funded Health Centers That Offer Family Planning Services. J Womens Health (Larchmt), 27(8):994-1000. doi: 10.1089/jwh.2017.6487. Epub 2018 Jan 29. PMID: 29377754; PMCID: PMC6742435.

[2] WHO. Strategies to strengthen referral from primary care to secondary care in low- and middle-income countries. World Health Organization Regional Office for South-East; 2019. https://apps.who.int/iris/bitstream/handle/10665/325734/9789290227090.

[3] Federal Democratic Republic of Ethiopia Ministory of Health (2010) Guidline for implementation of a patient referral system. https://www.ncbi.nlm.nih.gov.

[4] Abdi WO, Salgedo WB (2015) Magnitude and determinants of selfreferral of patients at a general hospital Western Ethiopia. Sci J Clin Med 4(5):86–92. doi: 10.11648/j.sjcm.20150405.12.

[5] Sørbye IK, Vangen S, Oneko O, Sundby J, Bergsjø P (2011) Caesarean section among referred and self-referred birthing women: a cohort study from a tertiary hospital, northeastern Tanzania. BMC Pregnancy Childbirth. 2011 Jul 28; 11:55. doi: 10.1186/1471-2393-11-55. PMID: 21798016; PMCID: PMC3160415.

[6] Koce F, Randhawa G, Ochieng B (2019) Understanding healthcare self-referral in Nigeria from the service users’ perspective: a qualitative study of Niger state. BMC Health Serv Res, 19(1):209. doi: 10.1186/s12913-019-4046-9. PMID: 30940134; PMCID: PMC6444603.

[7] Pillay I, Mahomed OH (2019) Prevalence and determinants of self-referrals to a District-Regional Hospital in KwaZulu Natal, South Africa: a cross sectional study. Pan Afr Med J, 33(4) doi: 10.11604/pamj.2019.33.4.16963. PMID: 31303949; PMCID: PMC6607454.

[8] Okoli H, Obembe T, Osungbade K, Adeniji F (2017) Self-referral patterns among federal civil servants in oyo state, South-Western Nigeria. Pan Afr Med J. 8(26):1-11. doi:10.11604/pamj.2017.26.105.11483.

[9] Wolkite Olani Abdi, Waju Beyene Salgedo, Gebeyehu Tsega Nebeb. (2015) Magnitude and Determinants of Self-Referral of Patients at a GeneralHospital, Western Ethiopia., Science Journal of Clinical Medicine, 4, (5), pp. 86-92. doi: 10.11648/j.sjcm.20150405.1

[10] Fisseha G, Berhane Y, Worku A, Terefe W (2017) Distance from health facility and mothers’ perception of quality related to skilled delivery service utilization in northern Ethiopia. Int J Womens Health, 9:749-756. doi: 10.2147/IJWH.S140366. PMID: 29042819; PMCID: PMC5633329.

[11] Eritero AC, Gebreslasie KZ, Asgedom AT, Areba AS (2022) Self ‑ referrals and associated factors among laboring mothers at Dilla University Referral Hospital, Dilla, Gedeo Zone, Ethiopia: a cross ‑ sectional study. BMC Womens Health 1-10. doi:10.1186/s12905-022-02002-7.

[12] Cervantes K, Salgado R, Choi M (2003) Rapid Assessment of Referral Care Systems. A guide for Program Managers. Edited by: Basic J, 66. https://m.facebook.com/221666151591142/posts/referral-systems-a-summary-of-key-processes-to-guide-health-services-managersan-/286883811736042/.

[13] Murray SF (2006) Maternity referral systems in developing countries: current knowledge and future research needs. Soc Sci Med 62(9):2205–15. https://doi.org/10.1016/j.socscimed.2005.10.025

[14] Abere, TM, Atnafu, DD & Mulu, Y (2021) Self-referral and associated factors among patients attending adult outpatient departments in Debre tabor general hospital, Northwest Ethiopia. BMC Health Serv Res 21, 607. https://doi.org/10.1186/s12913-021-06642-7

[15] Wambui M (2021) Determinants of Self Directed Referral Amongst Patients Seeking Health Services At Kenyatta National Hospital, Nairobi, Kenya.’ Afribary. Afribary, https://afribary.com/works/determinants-of-self-directed-referral-amongst-patients-seeking.

[16] National Population Commission (2006) NATIONAL CENSUS Nigeria.

[17] Elisso M (2016) Assessment of the Magnitude of Bypassing Public Health Center Delivery Service and Associated Factors among Postnatal Women in Negist Eleni Memorial Hospital, South Ethiopia Int J Community Med Public Health. Available at: http://thesisbank.jhia.ac.ke/id/eprint/7109 (Accessed on: 5th December 2023).

[18] Eshetie A, Belachew TB, Negash WD, Asmamaw DB, Muktar SA, Kebede A (2023) Self-referral practice and associated factors among women
who gave birth in South Gondar zone primary hospitals, Northwest Ethiopia: a cross-sectional study design. Front Public Health 1128845. doi: 10.3389/fpubh.2023.1128845. PMID: 37342276; PMCID: PMC10277469).

[19] Adoyo JO, Makunyi EG, Otieno GO, Yoos A (2021) Magnitude and determinants of self-referrals among women seeking skilled birth attendance services: a cross-sectional hospital-based study in Marsabit County, Kenya. Int J Community Med Public Health. 8:1. 10.18203/2394-6040.ijcmph20211728).

[20] Kruk ME, Hermosilla S, Larson E, Mbaruku GM (2014) Bypassing primary care clinics for childbirth: a cross-sectional study in the Pwani region, United Republic of Tanzania. Bull World Health Organ. (2014) 92:246–53. doi: http://dx.doi.org/10.2471/BLT.13.126417.