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.
Highlights
Sentinel surveillance for severe acute respiratory infections in hospitals and influenza-like illness in ambulatory clinics is recommended to assist in global pandemic influenza preparedness
These data can be used in a number of ways to support the interpretation of information from sentinel surveillance sites: first, to establish correction factors for estimates of incidence in the community based on numbers of cases presenting at the sentinel surveillance site, including the incidence in particular population sub-groups; second, to describe the actual catchment population accessing healthcare at the sentinel site to determine generalizability; and third, to identify other healthcare providers who may be recruited to participate in the surveillance system
Facilities, formally-employed workers who contribute to the Guatemalan Institute of Social Security (IGSS) can receive healthcare from IGSS hospitals and health centers, which are concentrated in Guatemala City
Summary
Sentinel surveillance for severe acute respiratory infections in hospitals and influenza-like illness in ambulatory clinics is recommended to assist in global pandemic influenza preparedness. [5,6,7,8,9,10,11,12] In HUS, random samples of the catchment population are interviewed with respect to their healthcare seeking and treatment behaviors during recent episodes of disease These data can be used in a number of ways to support the interpretation of information from sentinel surveillance sites: first, to establish correction factors for estimates of incidence in the community based on numbers of cases presenting at the sentinel surveillance site, including the incidence in particular population sub-groups; second, to describe the actual catchment population accessing healthcare at the sentinel site to determine generalizability; and third, to identify other healthcare providers who may be recruited to participate in the surveillance system.
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