Ursula Panzner1, Gi Deok Pak1, Peter Aaby2, Yaw Adu-Sarkodie3, Mohammad Ali4, Abraham Aseffa5, Stephen Baker6, Morten Bjerregaard-Andersen7, John A Crump8, Jessica Deerin1, Ligia Maria Cruz Espinoza1, Nagla Gasmelseed9, Jean Noël Heriniaina10, Julian T Hertz11, Justin Im1, Vera von Kalckreuth1, Karen H Keddy12, Bruno Lankoande13, Sandra Løfberg2, Christian G Meyer14, Michael Munishi Oresto15, Jin Kyung Park1, Se Eun Park1, Raphaël Rakotozandrindrainy10, Nimako Sarpong16, Abdramane Bassiahi Soura13, Amy Gassama Sow17, Adama Tall18, Mekonnen Teferi5, Alemayehu Worku19, Biruk Yeshitela5, Thomas F Wierzba1, Florian Marks1. 1. International Vaccine Institute, Seoul, Republic of Korea. 2. Bandim Health Project, Bissau, Guinea-Bissau. 3. Kumasi Centre for Collaborative Research in Tropical Medicine School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 4. International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins University, Baltimore, Maryland. 5. Armauer Hansen Research Institute, Addis Ababa, Ethiopia. 6. Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. 7. Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark. 8. Kilimanjaro Christian Medical Centre, Moshi, Tanzania Centre for International Health, University of Otago, Dunedin, New Zealand Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina. 9. Faculty of Medicine, University of Gezira, Wad Medani, Sudan. 10. University of Antananarivo, Madagascar. 11. Kilimanjaro Christian Medical Centre, Moshi, Tanzania Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina. 12. National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 13. University of Ouagadougou, Burkina Faso. 14. Institute of Tropical Medicine, Eberhard-Karls University, Tübingen, Germany. 15. Kilimanjaro Christian Medical Centre, Moshi, Tanzania. 16. Kumasi Centre for Collaborative Research in Tropical Medicine. 17. Institute Pasteur de Dakar Université Cheikh Anta Diop de Dakar, Senegal. 18. Institute Pasteur de Dakar. 19. School of Public Health, Addis Ababa University, Ethiopia.
Abstract
BACKGROUND: Assessing healthcare utilization is important to identify weaknesses of healthcare systems, to outline action points for preventive measures and interventions, and to more accurately estimate the disease burden in a population. METHODS: A healthcare utilization survey was developed for the Typhoid Fever Surveillance in Africa Program (TSAP) to adjust incidences of salmonellosis determined through passive, healthcare facility-based surveillance. This cross-sectional survey was conducted at 11 sites in 9 sub-Saharan African countries. Demographic data and healthcare-seeking behavior were assessed at selected households. Overall and age-stratified percentages of each study population that sought healthcare at a TSAP healthcare facility and elsewhere were determined. RESULTS: Overall, 88% (1007/1145) and 81% (1811/2238) of the population in Polesgo and Nioko 2, Burkina Faso, respectively, and 63% (1636/2590) in Butajira, Ethiopia, sought healthcare for fever at any TSAP healthcare facility. A far smaller proportion-namely, 20%-45% of the population in Bissau, Guinea-Bissau (1743/3885), Pikine, Senegal (1473/4659), Wad-Medani, Sudan (861/3169), and Pietermaritzburg, South Africa (667/2819); 18% (483/2622) and 9% (197/2293) in Imerintsiatosika and Isotry, Madagascar, respectively; and 4% (127/3089) in Moshi, Tanzania-sought healthcare at a TSAP healthcare facility. Patients with fever preferred to visit pharmacies in Imerintsiatosika and Isotry, and favored self-management of fever in Moshi. Age-dependent differences in healthcare utilization were also observed within and across sites. CONCLUSIONS: Healthcare utilization for fever varied greatly across sites, and revealed that not all studied populations were under optimal surveillance. This demonstrates the importance of assessing healthcare utilization. Survey data were pivotal for the adjustment of the program's estimates of salmonellosis and other conditions associated with fever.
BACKGROUND: Assessing healthcare utilization is important to identify weaknesses of healthcare systems, to outline action points for preventive measures and interventions, and to more accurately estimate the disease burden in a population. METHODS: A healthcare utilization survey was developed for the Typhoid Fever Surveillance in Africa Program (TSAP) to adjust incidences of salmonellosis determined through passive, healthcare facility-based surveillance. This cross-sectional survey was conducted at 11 sites in 9 sub-Saharan African countries. Demographic data and healthcare-seeking behavior were assessed at selected households. Overall and age-stratified percentages of each study population that sought healthcare at a TSAP healthcare facility and elsewhere were determined. RESULTS: Overall, 88% (1007/1145) and 81% (1811/2238) of the population in Polesgo and Nioko 2, Burkina Faso, respectively, and 63% (1636/2590) in Butajira, Ethiopia, sought healthcare for fever at any TSAP healthcare facility. A far smaller proportion-namely, 20%-45% of the population in Bissau, Guinea-Bissau (1743/3885), Pikine, Senegal (1473/4659), Wad-Medani, Sudan (861/3169), and Pietermaritzburg, South Africa (667/2819); 18% (483/2622) and 9% (197/2293) in Imerintsiatosika and Isotry, Madagascar, respectively; and 4% (127/3089) in Moshi, Tanzania-sought healthcare at a TSAP healthcare facility. Patients with fever preferred to visit pharmacies in Imerintsiatosika and Isotry, and favored self-management of fever in Moshi. Age-dependent differences in healthcare utilization were also observed within and across sites. CONCLUSIONS: Healthcare utilization for fever varied greatly across sites, and revealed that not all studied populations were under optimal surveillance. This demonstrates the importance of assessing healthcare utilization. Survey data were pivotal for the adjustment of the program's estimates of salmonellosis and other conditions associated with fever.
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