Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program.
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.
['Panzner|Ursula|U|', 'Pak|Gi Deok|GD|', 'Aaby|Peter|P|', 'Adu-Sarkodie|Yaw|Y|', 'Ali|Mohammad|M|', 'Aseffa|Abraham|A|', 'Baker|Stephen|S|', 'Bjerregaard-Andersen|Morten|M|', 'Crump|John A|JA|', 'Deerin|Jessica|J|', 'Cruz Espinoza|Ligia Maria|LM|', 'Gasmelseed|Nagla|N|', 'Heriniaina|Jean Noël|JN|', 'Hertz|Julian T|JT|', 'Im|Justin|J|', 'von Kalckreuth|Vera|V|', 'Keddy|Karen H|KH|', 'Lankoande|Bruno|B|', 'Løfberg|Sandra|S|', 'Meyer|Christian G|CG|', 'Oresto|Michael Munishi|MM|', 'Park|Jin Kyung|JK|', 'Park|Se Eun|SE|', 'Rakotozandrindrainy|Raphaël|R|', 'Sarpong|Nimako|N|', 'Soura|Abdramane Bassiahi|AB|', 'Gassama Sow|Amy|A|', 'Tall|Adama|A|', 'Teferi|Mekonnen|M|', 'Worku|Alemayehu|A|', 'Yeshitela|Biruk|B|', 'Wierzba|Thomas F|TF|', 'Marks|Florian|F|']
D000293:Adolescent D000328:Adult D017954:Africa South of the Sahara D000368:Aged D000369:Aged, 80 and over D002648:Child D002675:Child, Preschool D003430:Cross-Sectional Studies D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D008875:Middle Aged D010342:Patient Acceptance of Health Care D014435:Typhoid Fever D055815:Young Adult
typhoid fever healthcare utilization sub-Saharan Africa