Abstract
IntroductionHospital-based surveillance programs only capture people presenting to facilities and may underestimate disease burden. We conducted a healthcare utilisation survey to characterise healthcare-seeking behaviour among people with common infectious syndromes in the catchment areas of two sentinel surveillance hospitals in Johannesburg, South Africa.MethodsA cross-sectional survey was conducted within three regions of Johannesburg from August to November 2015. Premises were randomly selected from an enumerated list with data collected on household demographics and selected syndromes using a structured questionnaire. Fisher's exact or chi-square tests were used to determine association of characteristics among different regions.ResultsOf 3650 selected coordinates, 3358 were eligible dwellings and 2930 (87%) households with 9850 individuals participated. Four percent of participants (431/9850) reported influenza-like illness (ILI) in the last 30 days; equal numbers of participants (0.2%, 20/9850) reported pneumonia or tuberculosis symptoms in the last year and <1% reported diarrhoea or meningitis symptoms. Sixty eight percent (295/431) of participants who reported ILI, 75% (6/8) of children with diarrhoea and all participants who reported pneumonia (20), tuberculosis (20) or meningitis (6) sought healthcare. For all syndromes most sought care at registered healthcare providers. Of these only 10% (24/237) attended sentinel hospitals, predominantly those that lived closer to the hospitals. In contrast, of patients with meningitis, 50% (3/6) sought care at sentinel hospitals.ConclusionPatterns of seeking healthcare differed by syndrome and distance from facilities. Surveillance programs are still relevant in collecting information on infectious syndromes and reflect a proportion of the hospital's catchment area.
Highlights
In South Africa, tuberculosis, influenza and pneumonia were among the top ten causes of death in all age groups in 2014-2016 [1]
From 2012 the National Institute for Communicable Diseases (NICD) conducted prospective surveillance for persons with influenza-like illness (ILI) at outpatient clinics located in the catchment areas of two pneumonia surveillance sites [3]
A healthcare utilisation survey (HUS) captures information on health seeking behaviour that is missed by surveillance programs [7]
Summary
In South Africa, tuberculosis, influenza and pneumonia were among the top ten causes of death in all age groups in 2014-2016 [1]. Since 2009, the National Institute for Communicable Diseases (NICD) has conducted active, prospective, hospital-based surveillance for pneumonia in five of South Africa's nine provinces to describe its epidemiology, characterise causative pathogens and prepare for pandemics and outbreaks [2]. The disadvantage of facility-based surveillance programs is that they only capture information for people seeking healthcare at facilities conducting surveillance. This can lead to inaccurate interpretation of surveillance data as other people are missed [6]. A healthcare utilisation survey (HUS) captures information on health seeking behaviour that is missed by surveillance programs [7]. The study objective was to describe healthcare seeking behaviour for individuals with common infectious syndromes in the catchment areas of two sentinel surveillance hospitals in Johannesburg, South Africa
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