We approached 1200 households but residents could not be reached at 33 (3%) locations after three visits, and in 36 (3%), the household head declined to participate. We interviewed residents from 1131 (94%) households and gathered information on a total of 5449 persons of which 2806 (52%) were female and 586 (12%) were children <5 years old (Table ).
Sociodemographic characteristics among the population surveyed, and those with pneumonia in the previous 12 months or influenza-like illness (ILI) in the previous month, Santa Rosa, Guatemala, 2006a
We found 323 persons (6%, 95% confidence interval [CI] 6-7%) who met the pneumonia case definition in the previous year. Almost all (87%) met the case definition with self-reported cough and difficulty breathing for at least two days; 2% reported only a physician's diagnosis of pneumonia; and 12% reported both. There were 60 cases (11%, 95% CI 9-13%) of pneumonia reported among children <5 years old, and 263 cases (6%, 95% CI 5-6%) among persons aged five years or older. Among the children <5 years old, 31 (6%, 95% CI 5-7%) met the case definition for severe pneumonia.
The proportion of pneumonia cases reported by month increased from October 2005 through September 2006 (Figure .) More than half of the pneumonia cases were reported from the last five months prior to the survey.
Proportion of pneumonia cases reported by month of illness onset, Santa Rosa, Guatemala, October-December 2006.
There were 628 (13%, 95% CI 12-14%) persons who reported ILI in the previous month. A case of ILI was reported by 106 (19%, 95% CI 17-20%) children <5 years old and 522 (12%, 95 CI 11-13%) persons aged five years or older.
Characteristics of respondents with pneumonia and ILI
The most common symptoms reported by persons with pneumonia were difficult breathing (100%), cough (99%), and feverishness (88%) (Table ). The mean duration of illness of all persons with pneumonia was 13 days (range 2-120); more than one-quarter had symptoms for seven days or more.
Frequency of symptoms in people reporting pneumonia in the previous year and influenza-like illness (ILI) in the previous month, Santa Rosa, Guatemala, 2006a,b
Among persons who reported ILI, the most common symptom besides feverishness (100%) was sore throat (97%), headache (89%) and cough (88%). Signs of lower respiratory tract infection, such as difficult or fast breathing and wheezing, were less common among person who reported ILI than those with pneumonia. The mean duration of illness among persons with ILI was seven days (range 1-90); more than half of person who reported an ILI had symptoms for seven days or more.
The age distribution of persons with pneumonia was significantly different from the surveyed population without pneumonia (P<0.0001), with more children <5 years and adults ≥60 years old among the persons reporting pneumonia than among the surveyed population without pneumonia (Table ). Similarly, the age distribution of those with ILI was younger than the surveyed population without ILI (P = 0.001). The distribution of the person who reported ILI by household wealth index was significantly different from those without ILI (P<0.0001) with more cases among persons in the lowest wealth category and fewer in the wealthiest category. There was no difference in household wealth between persons with and without pneumonia (P = 0.14).
Among the 60 children <5 years old reporting pneumonia in the last year, 55 (92%) sought care outside the home. All subsequent analyses of healthcare-seeking behavior are based on those who sought care outside the home. Sixteen (27%) children sought care from more than one source. Hospitals were consulted by 17 (25%) children <5 years old with pneumonia, and most were government hospitals (Table ). Nine (12%) children <5 years old with pneumonia were admitted for at least one night in a hospital. Outpatient care providers were visited by 38 (75%) children <5 years old with reported pneumonia. Overall, the most frequently reported source of healthcare for children <5 years old with pneumonia were private ambulatory clinics, which attended to more than half the reported cases. More than half (55%) of the children <5 years old with reported pneumonia received care at least once during their illness from government facilities, either government hospitals or ambulatory clinics.
Healthcare providers consulted by respondents who sought care outside the home for pneumonia in the last year or influenza-like illness in the last month, Santa Rosa, Guatemala, 2006a
Among the 263 persons five years or older who reported pneumonia in the last year, 199 (73%) sought healthcare outside their home, with 21 (8%) seeking care from more than one source. Among persons in this age group who sought care outside the home, 28 (12%) sought care at hospitals (Table ), and 8 (4%) were admitted for at least one night. Government hospitals provided most of the hospitalized care. Among outpatient care providers, the most frequently sought source of care were private clinics, which provided care to 65 (31%) persons with pneumonia aged five years or older, along with government ambulatory clinics (46, 27%). A considerable proportion (16%) of persons with pneumonia aged five years or older sought care at pharmacies.
Care for ILI was sought outside the home by 87 (81%) children <5 years old, and 6 (6%) sought care from multiple sources (Table ). Government clinics were the source of healthcare most often consulted by children <5 years old for ILI; 34 (41%) children <5 years old reported seeking care at a government clinic, whereas 20 (20%) reported consulting a private clinic. Hospitals were consulted by 6 (5%) children <5 years old for ILI, and 4 (5%) were hospitalized for one night or more. Care was sought at pharmacies and drug shops for nearly one-third of children <5 years old with ILI.
Care for ILI was sought outside the home by 337 (65%) persons aged five years or older, and 13 (3%) consulted multiple sources. Government clinics were consulted for ILI by 111 (36%) persons aged five years or older. Pharmacies were consulted for ILI by 110 (29%) persons aged five years or older. One (0.1%) ILI patient five years or older was hospitalized for more than one night.
Among the respondents with pneumonia who did not seek healthcare for their illness, the perception that their illness was not severe enough to warrant treatment (28/69, 42%) and the cost of treatment (13/69, 20%) were the major reasons cited for not seeking care. Among persons with ILI who did not seek healthcare for their illness, insufficient severity of illness (68/204, 31%), cost of treatment (37, 18%), lack of medical services (13, 9%) and spontaneous improvement (19, 7%) were the major reasons cited.
Sociodemographic and illness characteristics associated with seeking treatment at government facilities
There was no significant association between sex of the respondent and whether care was sought for pneumonia (P = 0.34) or ILI (P = 0.15) at a government hospital or clinic (Table ). Children <5 years old were more likely to receive healthcare for pneumonia and ILI at government facilities than persons aged five years or older, but this difference was statistically significant only for pneumonia (P = 0.03). There was a significant inverse trend across SES status with persons of higher socioeconomic status less likely to seek care for pneumonia and ILI at government facilities (P = 0.005 and P = 0.001, respectively). The duration of illness was not associated with consultation at a government facility for either pneumonia (P = 0.37) or ILI (P = 0.25). Severity of pneumonia was not associated with seeking care from a government facility (P = 0.13).
Association between sociodemographic and illness characteristics and consultation for healthcare at government facilities for pneumonia or influenza-like illness (ILI), Santa Rosa, Guatemala, 2006