title: Putting surveillance data into context: the role of health care utilization surveys in understanding population burden of pneumonia in developing countries.
abstract: BACKGROUND
  Surveillance is essential to estimating the global burden of pneumonia, yet differences in surveillance methodology and health care-seeking behaviors limit inter-country comparisons.
  
  
  METHODS
  Results were compared from community surveys measuring health care-seeking for pneumonia defined as: (1) cough and difficulty breathing for ⩾2days; or, (2) provider-diagnosed pneumonia. Surveys were conducted in six sites in Guatemala, Kenya and Thailand; these sites also conduct, active, hospital- and population-based disease surveillance for pneumonia.
  
  
  RESULTS
  Frequency of self-reported pneumonia during the preceding year ranged from 1.1% (Thailand) to 6.3% (Guatemala) and was highest in children aged <5years and in urban sites. The proportion of persons with pneumonia who sought hospital-based medical services ranged from 12% (Guatemala, Kenya) to 80% (Thailand) and was highest in children <5years of age. Hospitals and private provider offices were the most common places where persons with pneumonia sought health care. The most commonly cited reasons for not seeking health care were: (a) mild illness; (b) already recovering; and (3) cost of treatment.
  
  
  CONCLUSIONS
  Health care-seeking patterns varied widely across countries. Using results from standardized health care utilization surveys to adjust facility-based surveillance estimates of pneumonia allows for more accurate and comparable estimates.
authors.affiliation: Respiratory Diseases Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Deutscher
authors.forename: Chris Van
authors.initials: CV
authors.lastname: Beneden
authors.forename: Deron
authors.initials: D
authors.lastname: Burton
authors.forename: Alvin
authors.initials: A
authors.lastname: Shultz
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Morgan
authors.forename: Shadi
authors.initials: S
authors.lastname: Chamany
authors.forename: Hannah T
authors.initials: HT
authors.lastname: Jordan
authors.forename: Xingyou
authors.initials: X
authors.lastname: Zhang
authors.forename: Brendan
authors.initials: B
authors.lastname: Flannery
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Feikin
authors.forename: Beatrice
authors.initials: B
authors.lastname: Olack
authors.forename: Kim A
authors.initials: KA
authors.lastname: Lindblade
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: Sonja J
authors.initials: SJ
authors.lastname: Olsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology*; D011159:Population Surveillance / Q000379:methods*; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
keywords: Comparative study; Health care; Patient acceptance of health care; Pneumonia; Population surveillance