Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program


Ursula Panzner, Gi Deok Pak, Peter Aaby, Yaw Adu-Sarkodie, Mohammad Ali, Abraham Aseffa, Stephen Baker, Morten Bjerregaard-Andersen, John A. Crump, Jessica Deerin, Ligia Maria Cruz Espinoza, Nagla Gasmelseed, Jean Noël Heriniaina, Julian T. Hertz, Justin Im, Vera von Kalckreuth, Karen H. Keddy, Bruno Lankoande, Sandra Løfberg, Christian G. Meyer, Michael Munishi Oresto, Jin Kyung Park, Se Eun Park, Raphaël Rakotozandrindrainy, Nimako Sarpong, Abdramane Bassiahi Soura, Amy Gassama Sow, Adama Tall, Mekonnen Teferi, Alemayehu Worku, Biruk Yeshitela, Thomas F. Wierzba, and Florian Marks


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.


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