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. 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 Panzner  1 , Gi Deok Pak  1 , Peter Aaby  2 , Yaw Adu-Sarkodie  3 , Mohammad Ali  4 , Abraham Aseffa  5 , Stephen Baker  6 , Morten Bjerregaard-Andersen  7 , John A Crump  8 , Jessica Deerin  1 , Ligia Maria Cruz Espinoza  1 , Nagla Gasmelseed  9 , Jean Noël Heriniaina  10 , Julian T Hertz  11 , Justin Im  1 , Vera von Kalckreuth  1 , Karen H Keddy  12 , Bruno Lankoande  13 , Sandra Løfberg  2 , Christian G Meyer  14 , Michael Munishi Oresto  15 , Jin Kyung Park  1 , Se Eun Park  1 , Raphaël Rakotozandrindrainy  10 , Nimako Sarpong  16 , Abdramane Bassiahi Soura  13 , Amy Gassama Sow  17 , Adama Tall  18 , Mekonnen Teferi  5 , Alemayehu Worku  19 , Biruk Yeshitela  5 , Thomas F Wierzba  1 , Florian Marks  1
Affiliations

Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program

Ursula Panzner et al. Clin Infect Dis. .

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.
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.
Figure 1.
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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