Prevalence and factors associated with timely completion of community health referrals in Palabek Refugee settlement, Lamwo District, Northern Uganda

Abstract

Introduction: Globally, community health workers are critical in ensuring access to essential primary health care services. In Uganda, the Ministry of Health has established guidelines for the regulation of community health services. Different types of community health workers exist and ensure preventive, promotive, and curative services reach their communities. Objective: To assess the prevalence of timely completion of community health referrals and identify associated factors in Palabek Refugee Settlement, Lamwo District, by May 2024, to inform targeted interventions. Methods: This was a mixed methods study done in Palabek refugee settlement. I conducted a cross-sectional survey amongst 2408 community members. The care takers were selected through systematic sampling. I conducted nine Focus Group Discussions and five Key Informant interviews. Quantitative data was analyzed using STATA version 14 and bivariable and multi-variable analysis were performed. Thematic analysis was used to analyze the qualitative data using Atlas.ti version 23 software. Results: The majority (1968/2408) of community health referrals, representing 81.73% were completed on time from May to November 2023. Factors associated with timely referral were income between 50,001 and 100,000 UG.Shs per month (aOR=1.75, 95%CI: 1.28-2.40, P<0.001), moderate vulnerability for food insecurity (aOR=1.54, 95%CI: 1.13-2.09, P=0.006), having a referral letter (aOR=1.83, 95%CI: 1.45-2.29, P<0.001), age (aOR=0.57, 95%CI: 0.40-0.79, P<0.001), perceiving illness as severe (aOR=0.76, 95%CI: 0.60-0.95, P=0.016) and having alternative options of care (aOR=0.75, 95%CI: 0.60-0.93, P=0.009). Conclusion and recommendations: Most, 8 in 10 community health referrals were completed on time. Several factors affect timely referral completion, and these include; income level, having a referral letter, age, access to alternative care points, and perception of disease severity. Livelihood support for refugees needs to be strengthened to enable refugees better access healthcare services. More community engagements should be organized to promote mindset change towards healthcare seeking.