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

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  • 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

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.

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