title: Health care utilization for acute illnesses in an urban setting with a refugee population in Nairobi, Kenya: a cross-sectional survey.
abstract: BACKGROUND
  Estimates place the number of refugees in Nairobi over 100,000. The constant movement of refugees between countries of origin, refugee camps, and Nairobi poses risk of introduction and transmission of communicable diseases into Kenya. We assessed the care-seeking behavior of residents of Eastleigh, a neighborhood in Nairobi with urban refugees.
  
  
  METHODS
  During July and August 2010, we conducted a Health Utilization Survey in Section II of Eastleigh. We used a multistage random cluster sampling design to identify households for interview. A standard questionnaire on the household demographics, water and sanitation was administered to household caretakers. Separate questionnaires were administered to household members who had one or more of the illnesses of interest.
  
  
  RESULTS
  Of 785 households targeted for interview, data were obtained from 673 (85.7%) households with 3,005 residents. Of the surveyed respondents, 290 (9.7%) individuals reported acute respiratory illness (ARI) in the previous 12 months, 222 (7.4%) reported fever in the preceding 2 weeks, and 54 (1.8%) reported having diarrhea in the 30 days prior to the survey. Children <5 years old had the highest frequency of all the illnesses surveyed: 17.1% (95% CI 12.2-21.9) reported ARI, 10.0% (95% CI 6.2-13.8) reported fever, and 6.9% (3.8-10.0) reported diarrhea during the time periods specified for each syndrome. Twenty-nine [7.5% (95% CI 4.3-10.7)] hospitalizations were reported among all age groups of those who sought care. Among participants who reported ≥1 illness, 330 (77.0%) sought some form of health care; most (174 [59.8%]) sought health care services from private health care providers. Fifty-five (18.9%) participants seeking healthcare services visited a pharmacy. Few residents of Eastleigh (38 [13.1%]) sought care at government-run facilities, and 24 (8.2%) sought care from a relative, a religious leader, or a health volunteer. Of those who did not seek any health care services (99 [23.0%]), the primary reason was cost (44.8%), followed by belief that the person was not sick enough (34.6%).
  
  
  CONCLUSIONS
  Health care utilization in Eastleigh is high; however, a large proportion of residents opt to seek care at private clinics or pharmacies, despite the availability of accessible government-provided health care services in this area.
authors.affiliation: Kenya Medical Research Institute, Mbagathi road off Mbagathi way, KEMRI main campus, CDC-Building, Nairobi, Kenya. cabeynuurdr@gmail.com.
authors.forename: Abdinoor Haji
authors.initials: AH
authors.lastname: Mohamed
authors.forename: Warren
authors.initials: W
authors.lastname: Dalal
authors.forename: Raymond
authors.initials: R
authors.lastname: Nyoka
authors.forename: Heather
authors.initials: H
authors.lastname: Burke
authors.forename: Jamal
authors.initials: J
authors.lastname: Ahmed
authors.forename: Erick
authors.initials: E
authors.lastname: Auko
authors.forename: Wilbert
authors.initials: W
authors.lastname: Shihaji
authors.forename: Irene
authors.initials: I
authors.lastname: Ndege
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Eidex
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012036:Refugees; D014505:Urban Population; D055815:Young Adult