Healthcare utilisation survey as part of the Hybrid model of the Surveillance of Enteric Fever in India (SEFI) study: processes, results, and challenges

Background Enteric fever is a significant health challenge in low and middle-income countries. “Surveillance of Enteric Fever in India” (SEFI) network was set up to obtain reliable incidence data. Six sites utilised a hybrid surveillance model, a combination of facility-based surveillance and community-based healthcare utilisation survey (HCUS). HCUS was performed to determine the percentage of the catchment population utilising the study facilities for febrile episodes, and is described here. Methods A two-stage sampling process was utilised for the HCUS to select 5000 households per site. Demographic data and healthcare-seeking behaviour were assessed. Results Febrile hospitalisation rate ranged from 2.5/1000 in Kullu to 9.6/1000 in Anantapur. The percentage of febrile admissions that sought care in the study hospital from the catchment area is 17% in Anantapur, 38% in Karimganj, 38% in Chandigarh, 10% in Nandurbar, 36% in Kullu and 24% in East Champaran respectively. Conclusions The variability in healthcare utilisation for fever admissions in the study hospitals underscores the importance of periodic healthcare utilisation surveys in hybrid surveillance. It is essential to adjust for those cases which have slipped out of the facility surveillance radar for obtaining an accurate estimate of the disease burden.