Pre-referral stabilization practices and associated early clinical outcomes among critically ill under-five children at regional referral hospitals in Dar es salaam, Tanzania

Abstract

ABSTRACT Background Pre-referral stabilization is a critical yet neglected component of pediatric emergency care in low-resource settings. It involves delivering life-saving interventions— such as airway management, oxygen therapy, fluids, glucose, and anticonvulsants at the initial point of care before referral. The WHO’s ETAT Guidelines emphasize the prompt recognition and management of life-threatening conditions in children to reduce mortality. Despite Tanzania’s adoption of ETAT, the extent to which pre-referral stabilization is practiced remains poorly documented. Strengthening pre-referral care through adherence to ETAT principles is essential to improve child survival and enhance the overall emergency response system. Objective To assess the pre-referral stabilization practices and associated early clinical outcomes among critically ill children under five years referred to Amana, Mwananyamala and Temeke Regional Hospitals in Dar es Salaam, Tanzania, during the study period. Methodology A hospital-based cross-sectional study that will be conducted from January 2026 to March 2026 at Amana, Mwananyamala, and Temeke Regional Referral Hospitals in Dar es Salaam, Tanzania. Consecutive eligible under-five children (0–59 months) referred from lower-level facilities who meet WHO ETAT emergency criteria will be enrolled (target n = 420). Data will be collected using a structured, pre-tested case report form capturing socio-demographic characteristics, pre-referral stabilization measures, and early outcomes within 72 hours post-admission. The primary outcome variable will be child final status (alive vs dead). Data will be analyzed in SPSS v23 using descriptive statistics, chi-square tests, and multivariable logistic regression to examine associations between pre-referral practices and early clinical outcomes.