Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Panzner, U; Pak, GD; Aaby, P; Adu-Sarkodie, Y; Ali, M; Aseffa, A; Baker, S; Bjerregaard-Andersen, M; Crump, JA; Deerin, J; Cruz Espinoza, LM; Gasmelseed, N; Heriniaina, JN; Hertz, JT; Im, J; von Kalckreuth, V; Keddy, KH; Lankoande, B; Løfberg, S; Meyer, CG; Oresto, MM; Park, JK; Park, SE; Rakotozandrindrainy, R; Sarpong, N; Soura, AB; Gassama Sow, A; Tall, A; Teferi, M; Worku, A; Yeshitela, B; Wierzba, TF; Marks, F

Published Date

  • March 15, 2016

Published In

Volume / Issue

  • 62 Suppl 1 / Suppl 1

Start / End Page

  • S56 - S68

PubMed ID

  • 26933023

Pubmed Central ID

  • PMC4772834

Electronic International Standard Serial Number (EISSN)

  • 1537-6591

Digital Object Identifier (DOI)

  • 10.1093/cid/civ891


  • eng

Conference Location

  • United States