title: Healthcare-seeking behaviour for common infectious disease-related illnesses in rural Kenya: a community-based house-to-house survey.
abstract: Community surveys of healthcare-use determine the proportion of illness episodes not captured by health facility-based surveillance, the methodology used most commonly to estimate the burden of disease in Africa. A cross-sectional survey of households with children aged less than five years was conducted in 35 of 686 census enumeration areas in rural Bondo district, western Kenya. Healthcare sought for acute episodes of diarrhoea or fever in the past two weeks or pneumonia in the past year was evaluated. Factors associated with healthcare-seeking were analyzed by logistic regression accounting for sample design. In total, 6,223 residents of 981 households were interviewed. Of 1,679 children aged less than five years, 233 (14%) had diarrhoea, and 736 (44%) had fever during the past two weeks; care at health facilities was sought for one-third of these episodes. Pneumonia in the past year was reported for 64 (4%) children aged less than five years; 88% sought healthcare at any health facility and 48% at hospitals. Seeking healthcare at health facilities was more likely for children from households with higher socioeconomic status and with more symptoms of severe illness. Health facility and hospital-based surveillance would underestimate the burden of disease substantially in rural western Kenya. Seeking healthcare at health facilities and hospitals varied by syndrome, severity of illness, and characteristics of the patient.
authors.affiliation: Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA. DBurton@ke.cdc.gov
authors.forename: Deron C
authors.initials: DC
authors.lastname: Burton
authors.forename: Brendan
authors.initials: B
authors.lastname: Flannery
authors.forename: Bernard
authors.initials: B
authors.lastname: Onyango
authors.forename: Charles
authors.initials: C
authors.lastname: Larson
authors.forename: Jane
authors.initials: J
authors.lastname: Alaii
authors.forename: Xingyou
authors.initials: X
authors.lastname: Zhang
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Hamel
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Feikin
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000453:epidemiology* / Q000628:therapy*; D003153:Community Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000628:therapy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology / Q000628:therapy; D011159:Population Surveillance / Q000379:methods*; D012424:Rural Population / Q000706:statistics & numerical data*; D055815:Young Adult