Otolaryngology Open Access Journal (OOAJ)
ISSN: 2476-2490
Research Article
Organization and Functionality of the Referral and Counter-Referral System for ENT Disorders in District Hospitals of N’Djamena, Chad: A Cross-Sectional Analytical Study
Abstract
Background: Ear, Nose, and Throat (ENT) disorders are a frequent reason for consultation in district hospitals in low-resource settings. The performance of referral and counter-referral systems is a key determinant of continuity and quality of care. This study aimed to describe the organization and functionality of the ENT referral system in district hospitals of N’Djamena and to identify professional factors associated with referral practices.
Methods: A cross-sectional analytical study was conducted from April to July 2023 among 157 non-specialist practitioners working in four district hospitals. Data were collected using a structured questionnaire. Associations were assessed using the Chi-square test and estimated by odds ratios (OR) with 95% confidence intervals (95% CI).
Results: Referral was practiced by 52.9% of participants (n = 83/157). The main reasons for referral were lack of diagnostic resources (94.0%, n = 78/83) and perceived insufficient expertise (84.3%, n = 70/83). Counter-referral feedback was absent in 77.1% of cases (n = 64/83). Professional experience ≤10 years (OR = 9.60; 95% CI: 4.37–21.07) and practical ENT training (OR = 8.54; 95% CI: 2.44–29.91) were significantly associated with referral practice.
Conclusion: The ENT referral system appears partially functional but marked by weak informational continuity. Strengthening formal counter-referral mechanisms and professional training represents a key organizational priority.
Keywords: Otorhinolaryngology; Referral System; Counter-referral; District Hospitals; Health System Organization; Chad
View PDF
