Objective: To examine the medical referral pattern of patients received
at the Muhimbili National Hospital (MNH) in order to inform the process
of strengthening the referral system. Methods: The study design was a
prospective study conducted at MNH during a 10-week study period from
January to March 2004. The study sample consisted of patients referred
to MNH Results: Of the 11,412 patients seen, 72.5% were
self-referrals. More than 70% of the patients seen required admission,
though not necessarily at tertiary level. Only 0.8% came from outside
the Dar es Salaam region. More than 70% of the patients seen required
admission. Surgical services were required by 66.8% of patients, with
obstetric conditions being most prominent (24.6% of all patients). For
those who were formally referred from other health services, lack of
expertise and equipment were the most common reasons given for referral
(96.3%). Conclusion: Efforts to improve referral systems in
low-income countries require that the primary and secondary level
hospitals services be strengthened and increased so as to limit
inappropriate use of national referral hospitals
