title: Low usage of government healthcare facilities for acute respiratory infections in guatemala: implications for influenza surveillance.
abstract: BACKGROUND
  Sentinel surveillance for severe acute respiratory infections in hospitals and influenza-like illness in ambulatory clinics is recommended to assist in global pandemic influenza preparedness. Healthcare utilization patterns will affect the generalizability of data from sentinel sites and the potential to use them to estimate burden of disease. The objective of this study was to measure healthcare utilization patterns in Guatemala to inform the establishment of a sentinel surveillance system for influenza and other respiratory infections, and allow estimation of disease burden.
  
  
  METHODS
  We used a stratified, two-stage cluster survey sample to select 1200 households from the Department of Santa Rosa. Trained interviewers screened household residents for self-reported pneumonia in the last year and influenza-like illness (ILI) in the last month and asked about healthcare utilization for each illness episode.
  
  
  RESULTS
  We surveyed 1131 (94%) households and 5449 residents between October and December 2006 and identified 323 (6%) cases of pneumonia and 628 (13%) cases of ILI. Treatment for pneumonia outside the home was sought by 92% of the children <5 years old and 73% of the persons aged five years and older. For both children <5 years old (53%) and persons aged five years and older (31%) who reported pneumonia, private clinics were the most frequently reported source of care. For ILI, treatment was sought outside the home by 81% of children <5 years old and 65% of persons aged five years and older. Government ambulatory clinics were the most frequently sought source of care for ILI both for children <5 years old (41%) and persons aged five years and older (36%).
  
  
  CONCLUSIONS
  Sentinel surveillance for influenza and other respiratory infections based in government health facilities in Guatemala will significantly underestimate the burden of disease. Adjustment for healthcare utilization practices will permit more accurate estimation of the incidence of influenza and other respiratory pathogens in the community.
authors: Centers for Disease Control and Prevention (CDC), Atlanta GA, 30333 USA. kil2@cdc.gov
authors: Kim A
authors: KA
authors: Lindblade
authors: April J
authors: AJ
authors: Johnson
authors: Wences
authors: W
authors: Arvelo
authors: Xingyou
authors: X
authors: Zhang
authors: Hannah T
authors: HT
authors: Jordan
authors: Lissette
authors: L
authors: Reyes
authors: Alicia M
authors: AM
authors: Fry
authors: Norma
authors: N
authors: Padilla
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D017050:Episode of Care; D035082:Federal Government; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006268:Health Facilities / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012111:Residence Characteristics; D057566:Self Report; D018571:Sentinel Surveillance; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology*; D013997:Time Factors