{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:39:57Z","timestamp":1785407997127,"version":"3.56.0"},"reference-count":27,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:00:00Z","timestamp":1747180800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: Pneumonia is the primary infectious cause of mortality in children under five, with approximately 800 000 deaths annually in low-income settings. In Kenya, pneumonia accounted for 16% of child deaths in 2022. Good treatment outcome relies on efficient referral system and timely hospital access. However, monitoring referral completion remained challenging in Endebess hospitals.\n\nAim: To assess determinants and key barriers to utilisation of community referral system.\n\nSetting: Seven public hospitals in Endebess sub-County in Kenya.\n\nMethods: This mixed-methods study involved 273 caregivers, 24 health personnel, 40 Community Health Volunteers (CHV\u2019s) and 4 Community Health Assistants. Data were collected using questionnaires and interviews. Quantitative analysis used Statistical Package for Social Sciences Version 22 (Chi-square, logistic regression; p &lt; 0.05). Qualitative data were analysed using thematic analyses.\n\nResults: Overall, 112 caregivers (41%) were referred. However, only 19 referral forms (17%) were filed at hospitals and 10 children (52.6%) recorded in service delivery logbook. Referral completion was significantly associated with distance to the hospital (p = 0.021), whether a CHV had accompanied the patient (p = 0.002) and household income (p= 0.040). Caregivers with self-help group savings were more likely to visit the hospital within 24 h of referral (p = 0.002, OR [odds ratio] = 3.8, 95% CI [confidence interval] = 1.639\u20138.813) than those without savings.\n\nConclusion: Utilising CHV diaries and household registers improves referral completion, highlighting the need for digital integration to strengthen data concordance.\n\nContribution: This study informed policymakers on strengthening community referrals by emphasising CHV report verification, mentorship on documentation and ensuring referral completion.<\/jats:p>","DOI":"10.4102\/jphia.v16i1.801","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T10:02:48Z","timestamp":1747044168000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Community referral system influencing caregiver health-seeking for childhood pneumonia in Endebess sub-county, Kenya"],"prefix":"10.4102","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7777-4799","authenticated-orcid":false,"given":"Everlyne","family":"Opuba","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5227-9571","authenticated-orcid":false,"given":"Patrick","family":"Onyango","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/023pskh72","id-type":"ROR","asserted-by":"publisher"}],"name":"Maseno University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6313-6501","authenticated-orcid":false,"given":"Jane","family":"Owenga","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03ffvb852","id-type":"ROR","asserted-by":"publisher"}],"name":"Jaramogi Oginga Odinga University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,5,14]]},"reference":[{"key":"ref0","unstructured":"Hosta S. One child dies of pneumonia every 39 seconds, agencies warn [homepage on the Internet]. UNICEF, 2019; [cited 2025 Apr 12]; p. 1\u201312. Available from: https:\/\/www.unicef.org\/turkiye\/en\/press-releases\/one-child-dies-pneumonia-every-39-seconds-agencies-warn%0Ahttps:\/\/www.unicef.org\/turkey\/en\/press-releases\/one-child-dies-pneumonia-every-39-seconds-agencies-warn"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Machuki JA, Omondi Aduda DS, Omondi AB, Onono MA. Patient-level cost of home- and facility-based child pneumonia treatment in Suba Sub County, Kenya. PLoS One. 2019;14(11):e0225194. https:\/\/doi.org\/10.1371\/journal.pone.0225194","DOI":"10.1371\/journal.pone.0225194"},{"key":"ref2","unstructured":"UNICEF. Child survival and the SDGs \u2013 UNICEF DATA. UNICEF data: Monitoring the situation of children and women [homepage on the Internet]. 2023 [cited 2025 Apr 12]. Available from: https:\/\/data.unicef.org\/topic\/child-survival\/child-survival-sdgs\/"},{"key":"ref3","unstructured":"UNICEF. Child mortality \u2013 UNICEF DATA [homepage on the Internet]. UNICEF, 2023 [cited 2025 Apr 12]; p. 1. Available from: https:\/\/data.unicef.org\/topic\/child-survival\/under-five-mortality\/"},{"key":"ref4","unstructured":"Pneumonia UNICEF [homepage on the Internet]. UNICEF; 2022 [cited 2025 Apr 12]. Available from: https:\/\/data.unicef.org\/topic\/child-health\/pneumonia\/"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Rigg J. The sustainable development goals (SDGS). Companion to Dev Stud. 2024;253\u2013257.","DOI":"10.4324\/9780429282348-52"},{"key":"ref6","unstructured":"UNICEF. The Integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). 2013;10."},{"key":"ref7","unstructured":"UNICEF, Save the Children, Coalition Every Breath Counts. 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Inquiry. 2020;57:46958020910305. https:\/\/doi.org\/10.1177\/0046958020910305","DOI":"10.1177\/0046958020910305"}],"container-title":["Journal of Public Health in Africa"],"original-title":[],"link":[{"URL":"https:\/\/publichealthinafrica.org\/index.php\/jphia\/article\/viewFile\/801\/1913","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/publichealthinafrica.org\/index.php\/jphia\/article\/viewFile\/801\/1914","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/publichealthinafrica.org\/index.php\/jphia\/article\/viewFile\/801\/1915","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/publichealthinafrica.org\/index.php\/jphia\/article\/viewFile\/801\/1916","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/publichealthinafrica.org\/index.php\/jphia\/article\/view\/801\/1916","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T03:49:11Z","timestamp":1747799351000},"score":1,"resource":{"primary":{"URL":"https:\/\/publichealthinafrica.org\/index.php\/jphia\/article\/view\/801"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,14]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/jphia.v16i1.801","relation":{},"ISSN":["2038-9922","2038-9930"],"issn-type":[{"value":"2038-9922","type":"print"},{"value":"2038-9930","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,14]]},"article-number":"a801"}}