International Health 3 (2011) 199–205 Contents lists available at ScienceDirect International Health journa l h omepa g e: h ttp ://www.elsevier.com/locate/inhe Reported healthcare utilisation for childhood respiratory illnesses in Vellore, South India Venkatesan Sankarapandian a,* , Ingrid K. Friberg b , Sushil Mathew John a , Sara Bhattacharji a , Mark C. Steinhoff b a Low Cost Effective Care Unit (LCECU), Christian Medical College Hospital, Vellore, India b International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA a r t i c l e i n f o Article history: Received 3 September 2010 Received in revised form 2 March 2011 Accepted 4 April 2011 Keywords: Respiratory illness Healthcare utilisation Children < 5 years India a b s t r a c t A 30-cluster survey using a modified WHO method was performed to assess the healthcare utilisation patterns for respiratory illnesses in Indian children < 5 years of age. Families of 600 children were interviewed to assess respiratory illness and healthcare utilisation during the previous month as well as hypothetical healthcare-seeking behaviour in the future. Based on parental report, 381 children (63.5%) had experienced a respiratory illness 1 month prior to the interview; 10 children were reported to have had severe pneumo- nia, 49 non-severe pneumonia and 322 upper respiratory illnesses (URI), extrapolating to 0.20 (95% CI 0.1–0.4), 0.98 (0.7–1.3) and 6.44 (6.0–6.9) cases per child-year, respectively. Five severe pneumonia cases (50%) were reported to have directly accessed care at a sec- ondary or tertiary care centre, whilst 18 children (36.7%) with non-severe pneumonia and 56 children (17.4%) with URI were reported to have been seen at secondary or tertiary centres. The remaining respiratory illnesses were reported to have been seen by primary care physicians, pharmacists, traditional healers and friends or were not seen by a health- care professional. This community-based Indian study suggests that, in this community, tertiary care surveillance alone may not accurately sample community disease, even for severe illnesses. © 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. 1. Introduction Pneumonia is a common cause of illness and death in children < 5 years of age in the developing world and accounts for approximately one-fifth of the 1.8 million deaths in children under 5 years in India. 1 A variety of infec- tious agents account for the high burden of morbidity in pneumonia. The causative organisms include respiratory syncytial virus, influenza virus, Haemophilus influenzae, Streptococcus pneumonia, Klebsiella spp., Escherichia coli and Staphylococcus aureus. 2–4 Effective vaccines are available * Corresponding author. Tel.: +91 416 228 1253; fax: +91 416 228 2486. E-mail address: venkatesh1970@gmail.com (V. Sankarapandian). against S. pneumoniae and H. influenzae, which are impor- tant causative organisms in children. However, they are not part of routine national immunisation programmes. Lack of information on the illness burden and cost effective- ness as well as high costs have contributed to their slow introduction in India and other countries. It is important to define the true burden of respiratory diseases in develop- ing countries in order to determine the need for preventive programmes. Passive hospital-based surveillance methods have been used to describe severe respiratory diseases. However, these methods may not comprehensively reflect the community-wide disease burden. Most hospital-based surveillance systems assume that data are obtained from the main, or only, treatment hospital or hospitals in the 1876-3413/$ – see front matter © 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.inhe.2011.04.001 at Dodd Library: Christian Medical College - Vellore on January 29, 2013 http://inthealth.oxfordjournals.org/ Downloaded from