Barriers to care, referrals and care-seeking prior to arrival at a tertiary pediatrics emergency department in Hanoi, Vietnam

Background: Improved emergency medicine services and referral networks could decrease child morbidity and mortality in low- and middle-income countries, including Vietnam. Where families face system and social barriers to care, such as cost and/or availability of transport, or delayed referrals, children may not access necessary critical care in a timely manner. We aimed to characterize emergency referrals and barriers to care at the National Hospital of Pediatrics (NHP), a national referral hospital in northern Vietnam.

Methods: This study includes a cross-sectional cohort of 598 children admitted through the hospital emergency department, randomly sampled at admission. Hospital records were reviewed for acuity, referral, diagnosis, and patient outcomes. Parents or accompanying relatives completed a 38-item self-administered questionnaire on socio-demographic characteristics, prior healthcare seeking, and barriers to care.

Results: The sample included 67.5% boys and 32.3% girls with a mean age of 26.4 months (SD 33.9 months). 44.7% of children had previously received care at the NHP; 59.9% received care at any facility within the previous year. 30.6% received a referral from another facility. 19.1% of families faced a barrier reaching the NHP. Time of transport (45.5%) and cost of transport (8.2%) were the most commonly reported barriers. Families with a referral were significantly more likely to report a barrier (p=.03).

Conclusions: The pediatric referral system may be amenable to a quality improvement intervention to reduce barriers as children are referred to higher-level facilities for critical care. Improvements to the referral system could further reduce child morbidity and mortality.