East and Central African Journal of Surgery
Association of Surgeons of East Africa and College of Surgeons of East Central and Southern Africa
Vol. 17, No. 3, 2012, pp. 98-101
Bioline Code: js12058
Full paper language: English
Document type: Research Article
Document available free of charge
East and Central African Journal of Surgery, Vol. 17, No. 3, 2012, pp. 98-101
© Copyright 2012 - East and Central African Journal of Surgery
Referral for Outpatients Urological Services: Poor Conformity and Pre-referral Evaluation in Western Kenya|
Musau, P. & Mteta, A.K.
Background: This study was aimed at establishing the degree of conformity with the referral system, level
of pre-referral investigative evaluations and degree of diagnosis concordance between the referring
centres and the referral hospital in Western region of Kenya.
Methods: This was a hospital based descriptive, prospective, cohort study. The Urology Outpatient clinic of
Moi Teaching and Referral Hospital (MTRH), a 750 bed tertiary centre in the Western region of Kenya
catering for approximately half of the Kenyan population.
Ninety-four first time attendees to the urology clinic seen in the year 2011. The primary outcome measures
were conformity with the referral system and the level of investigative evaluation prior to referral. The
secondary outcome measure was comparison between peripheral centre diagnosis and the diagnosis
made at the referral hospital.
Results: There was a predominance of males attending the urology clinic with the male to female ratio of
14.7: 1.Over a third (36.2%) of the patients were referred with the top three referring facilities being
District Hospitals (47%), Private Clinics (26.5%) and Mission Hospitals (11.8%). The factors that correlated
with likelihood of being referred were the administrative origin of patient (p <0.001), the centre attended
(p <0.001), the diagnosis made (p<0.001) and the age group (p=0.010). On multivariate analysis, the
greatest determinants of the need for referral were the centre attended and the diagnosis made (both
p<0.001). The diagnosis made was found to be the most powerful predictor of likelihood for referral. The
majority (88.2%) of the patients had clearly defined diagnoses from the referring centres but only 7.4%
had preliminary investigations prior to referral. There was a 76.7% concordance and 11.5% discrepancy in
diagnosis between the referring centre and the referral hospital.
Conclusion: The diagnoses made by the referring centres are correct in about three quarters of the
referrals but conformity with the referral system and the level of preliminary investigations prior to
referral are appallingly low.