Work

Typhoid fever surveillance in Africa program: Healthcare patterns in febrile study populations

Year: 2014

Type: article

Abstract: Background: The Typhoid Fever Surveillance in Africa Program (TSAP) aims at implementing passive surveillance of febrile bacterial bloodstream infections at sites in 10 sub-Saharan African countries to estimate the burden of typhoid fever, a vaccine-preventable disease of still uncertain morbidity and mortality. Findings of cross-sectional healthcare utilization surveys (HCUS) conducted in catchment areas of seven sites (Burkina Faso, Ethiopia, Guinea Bissau, Madagascar, Senegal, Sudan and Tanzania) are presented. Objectives of HCUS are to estimate the percentage of the catchment areas’ population that seek care for febrile episodes at recruitment healthcare facilities (HCFs), subsequently adjust incidence rates, and better understand healthcare utilization patterns (HUP). Methods & Materials: Boundaries and population sizes of catchment areas were determined using information such as data of demographic surveillance systems, census, and hospital records. A standardized questionnaire with coded, open- and closed-ended questions was deployed to adult respondents of randomly selected households. Overall and age-specific HUP were investigated across sites by examining responses to standardized and comparable situational indicators. Results: Preliminary analyses revealed that HUP vary considerably across and within sites of participating countries. Overall, recruitment HCFs are the first choice for more than 80% of the surveyed population in Burkina Faso, followed by 75% in Guinea Bissau, 64% in Ethiopia and 33% in Senegal. By contrast, only 18% of the surveyed population in an urban setting and 8% of the surveyed population in a rural setting in Madagascar seeks care at TSAP-HCFs. Results show that none of surveyed populations seek care solely at TSAP-HCFs but also elsewhere or decide not to seek care for fever at all. Conclusion: Survey findings may help to identify HCFs that are more adequate for surveillance of febrile illnesses and expose barriers in accessing HCFs. Findings also revealed that further explanations for differences in HUP need to be found. This includes assessment of site-specific characteristics like population density, demographics, availability and access to HCFs, existence or absence of financial schemes to cover medical costs, and unique cultural and educational factors. In-depth understanding of HUP is also crucial for public health authorities to improve existing healthcare systems and, in turn, benefit the population seeking care.

Source: International Journal of Infectious Diseases

DOI: 10.1016/j.ijid.2014.03.933