title: Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program.
abstract: 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.
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Ursula
authors.initials: U
authors.lastname: Panzner
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Gi Deok
authors.initials: GD
authors.lastname: Pak
authors.affiliation: Bandim Health Project, Bissau, Guinea-Bissau.
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Yaw
authors.initials: Y
authors.lastname: Adu-Sarkodie
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins University, Baltimore, Maryland.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ali
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: Abraham
authors.initials: A
authors.lastname: Aseffa
authors.affiliation: Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
authors.affiliation: Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Bjerregaard-Andersen
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania Centre for International Health, University of Otago, Dunedin, New Zealand Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina.
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Jessica
authors.initials: J
authors.lastname: Deerin
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Ligia Maria
authors.initials: LM
authors.lastname: Cruz Espinoza
authors.affiliation: Faculty of Medicine, University of Gezira, Wad Medani, Sudan.
authors.forename: Nagla
authors.initials: N
authors.lastname: Gasmelseed
authors.affiliation: University of Antananarivo, Madagascar.
authors.forename: Jean Noël
authors.initials: JN
authors.lastname: Heriniaina
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina.
authors.forename: Julian T
authors.initials: JT
authors.lastname: Hertz
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Justin
authors.initials: J
authors.lastname: Im
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Vera
authors.initials: V
authors.lastname: von Kalckreuth
authors.affiliation: National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Keddy
authors.affiliation: University of Ouagadougou, Burkina Faso.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lankoande
authors.affiliation: Bandim Health Project, Bissau, Guinea-Bissau.
authors.forename: Sandra
authors.initials: S
authors.lastname: Løfberg
authors.affiliation: Institute of Tropical Medicine, Eberhard-Karls University, Tübingen, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Meyer
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Michael Munishi
authors.initials: MM
authors.lastname: Oresto
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Jin Kyung
authors.initials: JK
authors.lastname: Park
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Se Eun
authors.initials: SE
authors.lastname: Park
authors.affiliation: University of Antananarivo, Madagascar.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Rakotozandrindrainy
authors.affiliation: Kumasi Centre for Collaborative Research in Tropical Medicine.
authors.forename: Nimako
authors.initials: N
authors.lastname: Sarpong
authors.affiliation: University of Ouagadougou, Burkina Faso.
authors.forename: Abdramane Bassiahi
authors.initials: AB
authors.lastname: Soura
authors.affiliation: Institute Pasteur de Dakar Université Cheikh Anta Diop de Dakar, Senegal.
authors.forename: Amy
authors.initials: A
authors.lastname: Gassama Sow
authors.affiliation: Institute Pasteur de Dakar.
authors.forename: Adama
authors.initials: A
authors.lastname: Tall
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: Mekonnen
authors.initials: M
authors.lastname: Teferi
authors.affiliation: School of Public Health, Addis Ababa University, Ethiopia.
authors.forename: Alemayehu
authors.initials: A
authors.lastname: Worku
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: Biruk
authors.initials: B
authors.lastname: Yeshitela
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Wierzba
authors.affiliation: International Vaccine Institute, Seoul, Republic of Korea.
authors.forename: Florian
authors.initials: F
authors.lastname: Marks
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D014435:Typhoid Fever / Q000453:epidemiology* / Q000628:therapy*; D055815:Young Adult
keywords: healthcare utilization; sub-Saharan Africa; typhoid fever