🎯 Learning Objectives

By the end of this lesson, learners will be able to:
✅ Understand when a newborn with jaundice must be referred to a hospital
✅ Identify clear referral criteria and red flags
✅ Explain the referral steps and roles of CHWs/TBAs in the process
✅ Navigate challenges like distance, cost, and cultural barriers to referral

🏥 Why Referral Is Critical

In newborn jaundice, timing = brain-saving.
Early referral to a hospital with testing and phototherapy can prevent kernicterus (brain damage), hearing loss, or even death.

🚨 When to Refer Immediately

📋 Standard Hospital Referral Steps (Simplified)

Step 1: Identify Urgent Signs

• CHW, TBA, or nurse checks for red flags using checklist

• Use Home Monitoring Card (Lesson 3 tool)

Step 2: Prepare Baby for Referral

• Keep warm, especially preterm/low birthweight babies

• Encourage breastfeeding before travel

• Avoid giving herbs, sugar water, or other delays

Step 3: Write/Send a Simple Referral Note

Example:
“Referral for neonatal jaundice. Onset <24 hrs, poor feeding, sleepy. No phototherapy at this facility. Needs bilirubin test + light therapy urgently.”

💬 Can be handwritten, texted, or WhatsApped to the facility nurse/matron

Step 4: Connect with Receiving Hospital (if possible)

• Call or message ahead to avoid delay

• Examples of tools:

  • MoH Referral Directory (Kenya): https://referral.mhealthkenya.org

  • Nigeria Health Facility Registry: https://hfr.health.gov.ng

Step 5: Assist with Transport / Escort

• Help family identify quickest route or link to:

  • CHW motorcycle/ambulance where available

  • Community referral fund (some counties, NGOs, or churches)

🛑 Referral Barriers & What to Do

🌍 Case Example – Ghana

A TBA in Ashanti noticed a baby with jaundice on Day 1. Using her CHW referral card, she contacted the Kumasi South District Hospital. The baby arrived within 2 hours, received phototherapy, and recovered fully. The family later became referral ambassadors for the clinic.

💬 CHW Talking Script (for Caregivers)

“Mama, your baby’s eyes and body are very yellow. This means the liver is struggling. If we wait, it could affect the brain. I will help you get to a hospital that has the right light treatment. It’s safe, and many babies recover quickly.”

📱 Useful Hotlines & Contacts (Regional Examples)

✅ Quiz – Hospital Referral

Q1. Which of these is a clear sign that a baby should be referred to hospital immediately?
A. Mild yellow in eyes only at Day 3
B. Baby is feeding well but yawns often
C. Baby has yellow palms and sleeps through feeds
D. Baby cries a lot when hungry

✅ Answer: C
Rationale: Yellowing of palms and extreme sleepiness may indicate severe jaundice needing urgent referral.

Q2. What is the role of the CHW or TBA during referral?
A. Give herbs before sending
B. Tell mother to wait for traditional rituals
C. Write or send a referral note, assist with transport, notify hospital
D. Do nothing and hope for the best

✅ Answer: C
Rationale: CHWs bridge the gap between home and hospital, making referrals faster and smoother.