Search

Why was the cohort set up?In many resource-constrained settings, availability of reli-able vital statistics and health information is limited bylack of proper system for civil registration and health infor-mation. This is further limited by the fact that the majorityof population health events, such as births, morbidity andmortality, occur outside the reach of these systems. In par-ticular, obtaining credible data from rural and remote ge-ographies can be even more constrained. The developmentof population-based surveillance systems in resource-constrained countries to monitor demographic and healthevents in these countries has as its basis the limited capac-ity of civil registration and health information systems.Locally rooted surveillance systems that are embedded inthe nexus of existing community structures and localhealth systems can serve to address this gap.

Background and methods Knowledge of utilization of health services and associated factors is important in planning and delivery of interventions to improve health services coverage. We determined the prevalence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions. We used a cluster sample survey design and interviewed household key informants on history of illness for household members and health services utilization in the preceding month. We estimated prevalence and performed random effects logistic regression to determine the influence of individual and household level factors on decisions to utilize health services. Results and conclusions 1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05–0.87)). Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources according to need and demand. The findings will also contribute in the development of community-level health coverage interventions that target the disadvantaged household groups.

Structure/Method/Design: The development of the textbook began with the editor recruiting an editorial board of diverse experts, who then assisted in determining textbook content and identifying pertinent clinicians as chapter authors. Leadership from the Consortium of Universities for Global Health and the former GHEC provided critical input on selecting editorial board members, chapter contributors, and textbook content. Chapter content was developed through an intense and iterative process between chapter authors and the editorial board, including several stages of drafting, reviewing, editing, and revising. We also partnered closely with illustrators from Wiley-Blackwell to produce a text rich in illustrations and photographs. Outcomes & Evaluation: Essential Clinical Global Health includes contributions from nearly 100 global health experts, with content organized into 37 chapters and 6 sections: Introduction; Newborn and Child Health; Adolescent, Reproductive, and Maternal Health; Infectious Diseases; Non-Communicable Diseases; and Other Global Health Topics. Chapters cover the clinical diagnosis, management, and prevention of the leading causes of morbidity and mortality in lowand middle-income countries, along with special chapters on resource-limited health systems and other contextual topics, for example, “Working clinically in resourcelimited settings,” “Preparing for travel and staying safe abroad,” “Neglected tropical diseases,” “Laboratory skills,” “Nursing care,” “Pharmacy,” “Global health technologies,” “Illness in returning travelers,” and “Developing a career in global health.” Each chapter features key learning objectives, evidence-based clinical guidelines, practical clinical skills, realworld experiences from trainees and clinicians in the field, and core readings. The textbook’s accompanying electronic supplement contains additional resources, videos, and self-assessment questions and answers as well as an electronic version of the complete textbook e valuable for reference abroad on a laptop, tablet, or mobile device. Going Forward: As this collaborative textbook is published the beginning of 2015, our goal is to make it widely accessible to individual global health students, trainees, and clinicians, as well as to all institutions with global health programs. We welcome feedback from the global health community on how to improve future editions of Essential Clinical Global Health. We are also working with WileyBlackwell to develop online CME offerings based upon the textbook. Funding: None Abstract #: 01ETC068