Healthcare Seeking and Access to Care for Pneumonia, Sepsis, Meningitis, and Malaria in Rural Gambia

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  • 1 Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, XXXXX, XXXXX;
  • | 2 Centre for International Health, University of Otago, Dunedin, New Zealand;
  • | 3 London School of Hygiene & Tropical Medicine, United Kingdom, XXXXX, XXXXX;
  • | 4 Medicines Control Agency, XXXXX, The Gambia;
  • | 5 Regional Health Team, Upper River Region, The Gambia;
  • | 6 Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand;
  • | 7 Murdoch Childrens Research Institute, Parkville, Melbourne, Australia;
  • | 8 Department of Paediatrics, University of Melbourne, Melbourne, Australia

Children with acute infectious diseases may not present to health facilities, particularly in low-income countries. We investigated healthcare seeking using a cross-sectional community survey, health facility-based exit interviews, and interviews with customers of private pharmacies in 2014 in Upper River Region (URR) The Gambia, within the Basse Health & Demographic Surveillance System. We estimated access to care using surveillance data from 2008 to 2017 calculating disease incidence versus distance to the nearest health facility. In the facility-based survey, children and adult patients sought care initially at a pharmacy (27.9% and 16.7% respectively), from a relative (23.1% and 28.6%), at a local shop or market (13.5% and 16.7%), and on less than 5% of occasions with a community-based health worker, private clinic, or traditional healer. In the community survey, recent symptoms of pneumonia or sepsis (15% and 1.5%) or malaria (10% and 4.6%) were common in children and adults. Rates of reported healthcare-seeking were high with families of children favoring health facilities and adults favoring pharmacies. In the pharmacy survey, 47.2% of children and 30.4% of adults had sought care from health facilities before visiting the pharmacy. Incidence of childhood disease declined with increasing distance of the household from the nearest health facility with access to care ratios of 0.75 for outpatient pneumonia, 0.82 for hospitalized pneumonia, 0.87 for bacterial sepsis, and 0.92 for bacterial meningitis. In rural Gambia, patients frequently seek initial care at pharmacies and informal drug-sellers rather than community-based health workers. Surveillance underestimates disease incidence by 8–25%.

Author Notes

Address correspondence to Ilias Hossain, Project Coordinator, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia. E-mail: mihossain@mrc.gm

Financial support: The work was supported by GAVI’s Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD), the Bill & Melinda Gates Foundation (OPP 1020372), and the UK Medical Research Council (MRC).

Authors’ addresses: Ilias Hossain, Momodou Jasseh, Kalifa Bojang, and Golam Sarwar, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, XXXXX, XXXXX, E-mails: mihossain@mrc.gm, mjasseh@mrc.gm, kbojang@mrc.gm, and gsarwar@mrc.gm. Philip Hill, Centre for International Health, University of Otago, Dunedin, New Zealand, E-mail: philip.hill@otago.ac.nz. Christian Bottomley and Brian Greenwood, London School of Hygiene & Tropical Medicine, XXXXX, United Kingdom, E-mails: christian.bottomley@lshtm.ac.uk and brian.greenwood@lshtm.ac.uk. Markieu Kaira, Medicines Control Agency, XXXXX, The Gambia, E-mail: mjannehkaira@mca.gm. Alhagie Sankareh, Regional Health Team, Upper River Region, The Gambia, E-mail: sankareh_a@yahoo.com. Steve Howie, Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine and Department of Paediatrics, Child and Youth Health, University of Auckland, Park Rd, Auckland, New Zealand, E-mail: stephen.howie@auckland.ac.nz. Grant MacKenzie, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, London School of Hygiene & Tropical Medicine, XXXXX, United Kingdom, Murdoch Childrens Research Institute, Parkville, Melbourne, Australia, and Department of Paediatrics, University of Melbourne, Australia, E-mail: grant.mackenzie@lshtm.ac.uk.

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