Low usage of government healthcare facilities for acute respiratory infections in guatemala: implications for influenza surveillance

Abstract

BackgroundSentinel 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.MethodsWe 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.ResultsWe 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%).ConclusionsSentinel 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.

Teacher led school-based surveillance can allow accurate tracking of emerging infectious diseases - evidence from serial cross-sectional surveys of febrile respiratory illness during the H1N1 2009 influenza pandemic in Singapore

“…A surveillance system built upon a small group of schools, as in the Sch-FRI system described here, would not allow central educational authorities to instigate responsive school closures in schools which are not enrolled in the network. However, self-reported ILI has been used successfully to investigate school-based outbreaks [9,33]; others have also used self-reported ILI to assess the burden of pdmH1N1 in the community and the proportions which seek care [24,35]. We believe that the school-based FRI reporting we describe offers some advantages over clinic-based ILI reporting: (i) it can be rapidly implemented in a centralized educational system, as in Singapore, (ii) it is not dependent on healthseeking behavior and can potentially work in areas with poor primary care coverage, (iii) it has clear denominators of the population at risk, and (iv) it does not require additional laboratory testing or serological studies.…”

Comparative epidemiology of human metapneumovirus‐ and respiratory syncytial virus‐associated hospitalizations in Guatemala

“…We adjusted rates upwards to account for: (i) the proportion of eligible cases by age group and surveillance site for which specimens were not tested for HMPV; and (ii) the proportion of the target populations with hospitalized ARI who sought care at the surveillance hospitals, as assessed by healthcare utilization surveys (HUS). In the HUS, among those who reported seeking care at a hospital in the previous 12 months for cough and difficulty breathing for ≥2 days, or clinician-diagnosed pneumonia, 53% in Santa Rosa21 and 60% in Quetzaltenango22 sought care for their illness at surveillance hospitals. We estimated the uncertainty in the adjusted incidence rates by repeating these calculations 1999 times, each time: (i) sampling from the binomial distribution [∼Bin( n = number missing, P = probability of HMPV among those tested)] to impute the number of HMPV infections among the eligible cases not tested for HMPV; (ii) bootstrap sampling from the HUS dataset the proportion of ARI cases for which care was sought at surveillance hospitals; and (iii) sampling from the Poisson distribution based on adjusted counts.…”

Putting surveillance data into context: The role of health care utilization surveys in understanding population burden of pneumonia in developing countries

“…1). Findings from several of these surveys have been published [3][4][5][6][7][8]. In Guatemala one survey was conducted in the Department of Santa Rosa (pop.…”