A healthcare-use survey was conducted in the Kibera informal settlement
in Nairobi, Kenya, in July 2005 to inform subsequent surveillance in
the site for infectious diseases. Sets of standardized questionnaires
were administered to 1,542 caretakers and heads of households with one
or more child(ren) aged less than five years. The average
household-size was 5.1 (range 1-15) persons. Most (90%) resided in a
single room with monthly rents of US$ 4.50-7.00. Within the previous
two weeks, 49% of children (n=1,378) aged less than five years
(under-five children) and 18% of persons (n=1,139) aged 655 years
experienced febrile, diarrhoeal or respiratory illnesses. The large
majority (>75%) of illnesses were associated with healthcareseeking.
While licensed clinics were the most-frequently visited settings,
kiosks, unlicensed care providers, and traditional healers were also
frequently visited. Expense was cited most often (50%) as the reason
for not seeking healthcare. Of those who sought healthcare, 34-44% of
the first and/or the only visits were made with non-licensed care
providers, potentially delaying opportunities for early optimal
intervention. The proportions of patients accessing healthcare
facilities were higher with diarrhoeal disease and fever (but not for
respiratory diseases in under-five children) than those reported from a
contemporaneous study conducted in a rural area in Kenya. The findings
support community-based rather than facility-based surveillance in this
setting to achieve objectives for comprehensive assessment of the
burden of disease