Utilization and Accessibility of Healthcare on Pemba Island, Tanzania: Implications for Health Outcomes and Disease Surveillance for Typhoid Fever

Linda M. Kaljee Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by Linda M. Kaljee in
Current site
Google Scholar
PubMed
Close
,
Alfred Pach Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by Alfred Pach in
Current site
Google Scholar
PubMed
Close
,
Kamala Thriemer Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by Kamala Thriemer in
Current site
Google Scholar
PubMed
Close
,
Benedikt Ley Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by Benedikt Ley in
Current site
Google Scholar
PubMed
Close
,
Said M. Ali Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by Said M. Ali in
Current site
Google Scholar
PubMed
Close
,
Mohamed Jiddawi Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by Mohamed Jiddawi in
Current site
Google Scholar
PubMed
Close
,
Mahesh Puri Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by Mahesh Puri in
Current site
Google Scholar
PubMed
Close
,
Lorenz von Seidlein Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by Lorenz von Seidlein in
Current site
Google Scholar
PubMed
Close
,
Jacqueline Deen Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by Jacqueline Deen in
Current site
Google Scholar
PubMed
Close
,
Leon Ochiai Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by Leon Ochiai in
Current site
Google Scholar
PubMed
Close
,
Thomas Wierzba Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by Thomas Wierzba in
Current site
Google Scholar
PubMed
Close
, and
John Clemens Wayne State University, Pediatric Prevention Research Center, The Carman and Ann Adams Department of Pediatrics, Detroit, Michigan; International Vaccine Institute, Seoul, Korea; The University of Vienna, Biocenter, Vienna, Austria; The Public Health Laboratory, Ivo de Carneri, Pemba Island, Tanzania; Ministry of Health and Social Welfare, Zanzibar, Tanzania; Menzies School of Health Research, Casuarina, NT, Australia

Search for other papers by John Clemens in
Current site
Google Scholar
PubMed
Close
Restricted access

Salmonella enterica serotype Typhi (S. Typhi) was estimated to cause over 200,000 deaths and more than 21 million illnesses worldwide, including over 400,000 illnesses in Africa. The current study was conducted in four villages on Pemba Island, Zanzibar, in 2010. We present data on policy makers', health administrators', and village residents' and leaders' perceptions of typhoid fever, and hypothetical and actual health care use among village residents for typhoid fever. Qualitative data provided descriptions of home-based treatment practices and use of western pharmaceuticals, and actual healthcare use for culture-confirmed typhoid fever. Survey data indicate health facility use was associated with gender, education, residency, and perceptions of severity for symptoms associated with typhoid fever. Data have implications for education of policy makers and health administrators, design and implementation of surveillance studies, and community-based interventions to prevent disease outbreaks, decrease risks of complications, and provide information about disease recognition, diagnosis, and treatment.

Author Notes

* Address correspondence to Linda M. Kaljee, Pediatric Prevention Research Center, Wayne State University School of Medicine, Hutzel Building, Suite W534, 4707 St. Antoine Street, Detroit, MI 48201. E-mail: lkaljee@med.wayne.edu

Financial support: This work was supported by a grant from the Swedish International Development Cooperation Agency (SIDA) to the International Vaccine Institute (IVI), Seoul, Korea.

Authors' addresses: Linda M. Kaljee, Pediatric Prevention Research Center, Wayne State University School of Medicine, Detroit, MI, E-mail: lkaljee@med.wayne.edu. Alfred Pach, Mahesh Puri, Leon Ochiai, and Thomas Wierzba, International Vaccine Institute, Seoul, South Korea, E-mails: pach3rd@aol.com, mkpuri@ivi.int, rlochiai@ivi.int, and twierzba@ivi.int. Kamala Thriemer, Institute for Tropical Medicine, Antwerp, Belgium, E-mail: kthriemer@itg.be. Benedikt Ley, University of Vienna, Biocenter, Vienna, Austria, E-mail: ley.benedikt@gmail.com. Said M. Ali, The Public Health Laboratory, Ivo de Cameri, Pemba Island, Zanzibar, E-mail: saidmali2003@yahoo.com. Mohamed Jiddawi, Ministry of Health of Tanzania, E-mail: m_jiddawi@hotmail.com. Lorenze von Seidlein and Jacqueline Deen, Menzies School of Health Research, Casuarina NT, Australia, E-mails: lseidlein@gmail.com and deen.jacqueline@gmail.com. John Clemens, University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, E-mail: jdclemens@ucla.edu.

  • 1.

    Crump JA, Luby SP, Mintz ED, 2004. The global burden of typhoid fever. Bull World Health Organ 82: 346–353.

  • 2.

    Klugman KP, Koornhof HJ, Robbins JB, Le Cam NN, 1996. Immunogenicity, efficacy, and serological correlate of protection of Salmonella Typhi Vi capsular polysaccharide vaccine three years after immunization. Vaccine 14: 435–438.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Crump JA, Ram PK, Gupta SK, Miller MA, Mintz ED, 2008. Part 1: analysis of data gaps pertaining to Salmonella enterica serotype Typhi infection in low and medium human development index countries 1984–2005. Epidemiol Infect 136: 436–448.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Reddy EA, Shaw AV, Crump JA, 2010. Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis 10: 417–432.

  • 5.

    Brent A, Ahmed I, Ndiritu M, Lewa P, Ngetsa C, Lowe B, Bauni E, English M, Berkeley JA, Scott JA, 2006. Incidence of clinically significant bacteraemia in children who present to hospital in Kenya: community-based observational study. Lancet 367: 482–488.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Berkley JA, Lowe B, Mwangi I, Williams T, Bauni E, Mwarumba S, Ngetsa C, Slack MP, Njenga S, Hart CA, Maitland K, English M, Marsh K, Scott JA, 2005. Bacteremia among children admitted to a rural hospital in Kenya. N Engl J Med 352: 39–47.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Rowe B, Ward LR, Threlfall EJ, 1997. Multi-drug resistant Salmonella typhi: a worldwide epidemic. Clin Infect Dis 24 (Suppl 1): S106–S109.

  • 8.

    Weill FX, 2010. Typhoid fever: facing the challenges of resistant strains. Med Sci (Paris) 26: 969–975 [English abstract].

  • 9.

    Ordinioha B, Onvenaporo C, 2010. Experience with use of community health extension workers in primary care in a private rural health care institution in South South-Nigeria. Ann Afr Med 9: 240–245.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Damien P, Nabure C, Barden F, Kwara E, Apanga S, Etego-Amengo S, 2011. How are surgical theatres in rural Africa utilized? A review of five years of services at a district hospital in Ghana. Trop Doct 41: 91–95.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Thriemer K, Ley B, Ame S, von Seidlein L, Pak GD, Chang NY, Hashim R, Schmied WH, Busch CJ, Nixon S, Morrissey A, Puri MK, Ali M, Ochiai RL, Wierzba T, Jiddawi MS, Clemens JD, Ali SM, Deen JL, 2012. The burden of invasive bacterial infections in Pemba, Zanzibar. PLoS ONE 7: e30350.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    World Health Organization, 2009. Initiative for Vaccine Research. Diarrhoeal Diseases. Available at: http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.html. Accessed July 1, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    USAID, 2009. Infectious Diseases, Surveillance Types. Available at: http://www.usaid.gov/our_work/global_health/id/surveillance/overview.html. Accessed July 1, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    U.S. Department of State, 2011. Bureau of African Affairs, Background Note: Tanzania. Available at: http://www.state.gov/r/pa/ei/bgn/2843.htm. Accessed June 28, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    The World Bank, 2011. GNI per capita, Atlas method (current US$). Available at: http://data.worldbank.org/indicator/NY.GNP.PCAP.CD. Accessed June 28, 2011.

  • 16.

    The United Republic of Tanzania, 2006. National Bureau of Statistics, Analytical Report. Available at: http://www.nbs.go.tz/pdf/2002popcensus.pdf. Accessed June 28, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Revolutionary Government of Zanzibar, Ministry of Health and Social Welfare, 2006. Zanzibar Health Sector Reform, Strategic Plan II. 2006/7–2010/11. Accessed at: http://www.healthresearchweb.org/files/Zanzibar%20Health%20Sector%20Reform%20Strategic%20Plan%20II%202007-2011.pdf. Accessed July 6, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    World Health Organization, n.d. Environmental and Social Health Determinants of Zanzibar. Available at: http://www.who.int/social_determinants/country_action/Zanzibar%20Presentation%20Dr%20JUMA.pdf. Accessed July 6, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Kaljee L, Pham V, Son ND, Hoa NT, Thiem VD, Canh DG, Thoa LTK, Ali M, Ochiai RL, Danovaro-Holliday C, Acosta C, Stanton B, Clemens J, 2007. Trial participation and vaccine desirability for polysaccharide Vi typhoid fever vaccine in Hue City, Viet Nam. Trop Med Int Health 12: 25–36.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Sur D, Manna B, Chakrabarty N, Kaljee LM, Riel R, Pach A, Kanungo S, Deen J, Ochiai RL, Clemens J, Bhattacharya SK, 2009. Vaccine desirability during an effectiveness trial of the typhoid fever polysaccharide Vi vaccine, Kolkata India. Hum Vaccin 5: 614–620.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Young SL, 2002. Listen, Without Blood There Is No Life: An Ethnography of Anemia during Pregnancy in Pemba, Zanzibar. Available at: http://amma.socsci.uva.nl/theses/young.pdf. Accessed June 15, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Treetop-ics, 2008. Available at: http://treetop-ics.blogspot.com/2008/11/mwarubaini.html. Accessed June 15, 2011.

    • PubMed
    • Export Citation
  • 23.

    Neuwinger Dieter H, 1994. African Ethnobotany: Poisons and Drugs: Chemistry, Pharmacology, Toxicology [English translation by Aileen Porter and H. Dieter Neuwinger]. Weinheim, Germany: Chapman and Hall.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Stoner BP, 1986. Understanding medical systems: traditional, modern and syncretic health care alternatives in medically pluralistic societies. Med Anthropol Q 17: 44–48.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Kaljee L, Anh DD, Minh TT, Tho LH, Batmunkh N, Kilgore P, 2011. Rural and urban Vietnamese mothers utilization of biomedical and traditional healthcare resources for infants and young children with pneumonia and associated symptoms. J Behav Med 34: 254–267.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Amin R, Shah NM, Becker S, 2010. Socioeconomic factors differentiating maternal and child health-seeking behavior in rural Bangladesh: a cross-sectional analysis. Int J Equity Health 3: 9.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    DeRoeck D, Clemens JD, Nyamete A, Mahoney RT, 2005. Policymakers views regarding the introduction of new generation vaccines against typhoid fever, shigellosis and cholera in Asia. Vaccine 23: 2762–2774.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    DeRoeck D, Jodar L, Clemens JD, 2007. Putting typhoid vaccination on the global health agenda. N Engl J Med 357: 1069–1071.

Past two years Past Year Past 30 Days
Abstract Views 1836 1677 54
Full Text Views 521 11 0
PDF Downloads 115 12 0
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save