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J Prim Care Community Health. 2010 Oct 1;1(3):213-7. doi: 10.1177/2150131910380238.

Intervention to reduce parental bypass of community pediatric primary health facilities in asmara, eritrea.

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  • 1Department of Pediatrics, UC Davis Medical Center, University of California, Davis, Sacramento, CA, USA.



To reduce direct parental referral of low acuity ill pediatric patients to the outpatient facilities of a nation's only pediatric referral hospital.


Longitudinal monitoring of outpatient visits at Orotta Children's Hospital (OCH) and primary health facilities (PHFs) following implementation of an intervention designed in response to information provided by parents and health-care providers. Parental surveys were undertaken before and after exposure to the intervention to assess effects on knowledge, attitudes, and behavioral intentions.


We analyzed 5,639 visits between baseline and follow-up, documenting a decline in parental referral among OCH outpatients from 95% to approximately 80%. Educational intervention increased the proportion of parents intending to use PHF for future outpatient care from 28% to 82%. Staff of the PHFs responded enthusiastically to this intervention program and requested further activities.


Self-referral to tertiary care hospital was reduced following a modest program of parental education designed and implemented by residents in training.


community health; developing nation; health services accessibility; pediatric; primary care

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