Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program

doi:10.1093/cid/civ891

. 2016 Mar 15;62 Suppl 1(Suppl 1):S56-68.

doi: 10.1093/cid/civ891.

Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program

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

Affiliations

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.

PMID: 26933023
PMCID: PMC4772834
DOI: 10.1093/cid/civ891

Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program

Ursula Panzner et al. Clin Infect Dis. 2016.

. 2016 Mar 15;62 Suppl 1(Suppl 1):S56-68.

doi: 10.1093/cid/civ891.

Authors

Affiliations

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.

PMID: 26933023
PMCID: PMC4772834
DOI: 10.1093/cid/civ891

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.

Keywords: healthcare utilization; sub-Saharan Africa; typhoid fever.

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Figures

**Figure 1.**
A and B, Utilization of healthcare for fever lasting <3 days by study site, Typhoid Fever Surveillance in Africa Program (TSAP), 2011–2013. The horizontal axis represents precategorized healthcare utilization options. Dark gray columns, healthcare utilization at public TSAP-healthcare facilities; light gray columns, healthcare utilization at other public or private healthcare facilities, and alternative options (eg, self-management, traditional healer, medical practitioner, pharmacy, nothing). The vertical axis represents crude percentages for utilizing healthcare among the interviewed study populations of all ages and both sexes in the event of fever lasting <3 days. 95% confidence intervals are indicated by error bars and raw figures above each respective column. Abbreviations: CMA, Centres Médicaux avec Antennes chirurgicales; CSB, Centres Santé de Bases; CSPS, Centre de Santé et de Promotion Social; IPS, Institut de Pédiatrie sociale de Pikine.

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References

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[1] United Nations. Millennium Development Goals and beyond 2015. Available at: http://www.un.org/millenniumgoals/. Accessed 10 August 2015.

[2] United Nations. Millennium Development Goals and beyond 2015. Available at: http://www.un.org/millenniumgoals/. Accessed 10 August 2015.

[3] World Health Organization. Global health observatory data repository 2015. Available at: http://apps.who.int/gho/data/node.resources. Accessed 20 August 2015.

[4] World Health Organization. Global health observatory data repository 2015. Available at: http://apps.who.int/gho/data/node.resources. Accessed 20 August 2015.

[5] United Nations Development Program. Human development reports. Available at: http://hdr.undp.org/en/content/human-development-index-hdi. Accessed 20 August 2015.

[6] United Nations Development Program. Human development reports. Available at: http://hdr.undp.org/en/content/human-development-index-hdi. Accessed 20 August 2015.

[7] World Bank Group. The World Bank 2015. Available at: http://www.worldbank.org/. Accessed 20 August 2015.

[8] World Bank Group. The World Bank 2015. Available at: http://www.worldbank.org/. Accessed 20 August 2015.

[9] Bigogo G, Audi A, Aura B, Aol G, Breiman RF, Feikin DR. Health-seeking patterns among participants of population-based morbidity surveillance in rural western Kenya: implications for calculating disease rates. Int J Infect Dis 2010; 14:e967–73. - PubMed

[10] Bigogo G, Audi A, Aura B, Aol G, Breiman RF, Feikin DR. Health-seeking patterns among participants of population-based morbidity surveillance in rural western Kenya: implications for calculating disease rates. Int J Infect Dis 2010; 14:e967–73. - PubMed

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Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program

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Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program

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