Reported healthcare utilisation for childhood respiratory illnesses in Vellore, South India
Venkatesan Sankarapandian1, Ingrid K Friberg, Sushil Mathew John
1Low Cost Effective Care Unit (LCECU), Christian Medical College Hospital, Vellore, India.
Insights
This study on Indian children under 5 found that most respiratory illnesses, including pneumonia and upper respiratory illnesses (URI), are treated in primary care. Relying solely on tertiary care surveillance may miss community disease patterns.
Area of Science:
- Pediatric Respiratory Illnesses
- Healthcare Utilization Studies
- Public Health Surveillance
Background:
- Respiratory illnesses are a major cause of morbidity in children under 5 years globally.
- Understanding healthcare-seeking behaviors is crucial for effective public health interventions in diverse settings.
- Previous studies often focus on hospital-based data, potentially underestimating community-level disease burden.
Purpose of the Study:
- To assess healthcare utilization patterns for respiratory illnesses in Indian children under 5 years of age.
- To determine the prevalence of different types of respiratory illnesses in the community.
- To compare healthcare-seeking behaviors for severe versus non-severe respiratory conditions.
Main Methods:
- A community-based survey was conducted in 30 clusters across India.
- A modified World Health Organization (WHO) method was employed for data collection.
- Interviews with families of 600 children assessed recent respiratory illnesses and healthcare-seeking behavior.
Main Results:
- 63.5% of children experienced a respiratory illness in the month prior to the survey.
- Prevalence rates were estimated at 0.20 cases/child-year for severe pneumonia, 0.98 for non-severe pneumonia, and 6.44 for upper respiratory illnesses (URI).
- Only 50% of severe pneumonia cases accessed secondary or tertiary care; lower percentages were reported for non-severe pneumonia and URI, with many seeking primary care or alternative treatments.
Conclusions:
- Tertiary care surveillance alone may not accurately reflect the true community disease burden, even for severe pediatric respiratory illnesses in this Indian setting.
- A significant proportion of respiratory illnesses are managed within primary care or through non-formal healthcare channels.
- Findings highlight the need for integrated surveillance systems that capture data from all levels of healthcare utilization.
Abstract:
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 pneumonia, 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 secondary 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 healthcare 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.
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