Open Access Research article

Low usage of government healthcare facilities for acute respiratory infections in guatemala: implications for influenza surveillance

Kim A Lindblade12*, April J Johnson3, Wences Arvelo12, Xingyou Zhang1, Hannah T Jordan3, Lissette Reyes4, Alicia M Fry1 and Norma Padilla5

Author Affiliations

1 Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd., Atlanta GA, 30333 USA

2 CDC Regional Office for Central America and Panama, 18 Avenida, 11-95 Zona 15, Guatemala City, Guatemala

3 Epidemic Intelligence Service, CDC, Atlanta, GA 30333 USA

4 Field Epidemiology Training Program, Ministerio de Salud Pública y Asistencia Social, 6 Avenida 3-45 Zona 11, Guatemala City, Guatemala

5 CDC-UVG Collaboration, Universidad del Valle de Guatemala,18 Avenida, 11-95 Zona 15, Guatemala City, Guatemala

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BMC Public Health 2011, 11:885  doi:10.1186/1471-2458-11-885

Published: 24 November 2011



Sentinel surveillance for severe acute respiratory infections in hospitals and influenza-like illness in ambulatory clinics is recommended to assist in global pandemic influenza preparedness. Healthcare utilization patterns will affect the generalizability of data from sentinel sites and the potential to use them to estimate burden of disease. The objective of this study was to measure healthcare utilization patterns in Guatemala to inform the establishment of a sentinel surveillance system for influenza and other respiratory infections, and allow estimation of disease burden.


We used a stratified, two-stage cluster survey sample to select 1200 households from the Department of Santa Rosa. Trained interviewers screened household residents for self-reported pneumonia in the last year and influenza-like illness (ILI) in the last month and asked about healthcare utilization for each illness episode.


We surveyed 1131 (94%) households and 5449 residents between October and December 2006 and identified 323 (6%) cases of pneumonia and 628 (13%) cases of ILI. Treatment for pneumonia outside the home was sought by 92% of the children <5 years old and 73% of the persons aged five years and older. For both children <5 years old (53%) and persons aged five years and older (31%) who reported pneumonia, private clinics were the most frequently reported source of care. For ILI, treatment was sought outside the home by 81% of children <5 years old and 65% of persons aged five years and older. Government ambulatory clinics were the most frequently sought source of care for ILI both for children <5 years old (41%) and persons aged five years and older (36%).


Sentinel surveillance for influenza and other respiratory infections based in government health facilities in Guatemala will significantly underestimate the burden of disease. Adjustment for healthcare utilization practices will permit more accurate estimation of the incidence of influenza and other respiratory pathogens in the community.