GEMS1 HUAS/HUAS Lite Survey

Related studies:

GEMS1 Case Control
GEMS1A Case Control
GEMS1A HUAS Lite Survey

Background: The Global Enteric Multicenter Study (GEMS) 1 HUAS/HUAS Lite surveys were two community-based Healthcare Services Utilization and Attitudes Surveys (HUAS) conducted in conjunction with the GEMS1 Case Control study. These surveys provide data on where parents seek care when their children have diarrheal disease, and their attitudes and practices concerning diarrhea, its prevention and treatment.

Ideally 100% of patients with moderate-to-severe diarrhea would have received care at the hospital(s) or urgent care setting(s) participating in the study at the field site where cases of moderate-to-severe diarrhea were counted and analyzed, designated henceforth as the "sentinel health centers". Because the catchment population at most of the sites was quite large and there are typically multiple sources of health care, it may be logistically impractical to maintain both surveillance for moderate-to-severe diarrhea and the ability to enroll patients into the case-control study at all the health care facilities that serve the population. Moreover, at each site some fraction of children would not reach a health care facility when they have moderate-to-severe diarrhea. If the HUAS indicates that the point estimate of patients with moderate-to-severe diarrhea treated at the sentinel health centers falls below 75%, measures were taken to try and increase this percentage by including additional health care facilities in the surveillance.

Objectives: Data from the GEMS1 1 HUAS/HUAS Lite surveys was used in different ways-

To optimize the surveillance for determining disease burden
To perform data adjustments to account for the proportion of children with diarrhea who do not seek care at the health care facilities participating in GEMS surveillance
To calculate population-based incidence rates
To compare data between the different sites
To assess public perception of the need for interventions to prevent childhood diarrhea

Methodology:

Geographic Location/Study Sites: Seven GEMS sites with moderate-to-high under-five child mortality participated in GEMS1, four in Africa (Bamako, Mali; Manhiça, Mozambique; Basse, The Gambia; and Nyanza Province, Kenya) and three in Asia (Mirzapur, Bangladesh; Kolkata, India; and Bin Qasim Town, Karachi, Pakistan).

Dates of Data Collection: March 2007- December 2010; the HUAS survey was conducted at the beginning of the study and HUAS Lite was conducted twice a year over the course of the study.

Study Design: Community-based Cross-sectional Survey

Eligibility Criteria: From the census at each study site, updated by ongoing demographic surveillance, computerized lists of children were constructed for each of the age groups of interest (0-11, 12-23, and 24-59 months). The census databases were as current as possible, in order to include recent births and to put children who have crossed an age group boundary in the appropriate group. The list defines the population from which the HUAS sample is drawn. Even with the updated list, there may be births between the time of preparation of the list and conduct of the survey, so that infants at the earliest ages may be somewhat underrepresented in the HUAS.

Each of the sites selected a random selection of approximately 400 eligible from the 0-11 month age group (over-sampled because of the potential difficulties locating children in this age group, e.g., because of aging and higher mortality rates), and 370 eligible children from each of the two older age strata (12-23 months and 24-59 months) using the updated census list.

Data Collection: The interviewer went to the child's home and described the study to the selected child's parent or primary caretaker. If the parent or primary caretaker wished to participate, the consent form was read aloud by the interviewer in the local language and the parent/primary caretaker was given an opportunity to ask questions. Thereafter, s/he would either provide a signature or (if s/he did not know how to write) place a mark on the consent form (this could be an "x" or a fingerprint) in the presence of a witness (who would also sign the form) indicating his/her willingness to participate. The parent or primary caretaker received a copy of the signed consent form to keep and the original was stored in the regulatory files at the study site. The respondent was the child's primary caretaker. If a primary caretaker was not available, this was recorded and the interviewer tried to leave a message indicating when the interviewer would be likely to return. A total of 3 attempts were made to contact a primary caretaker after which time the child was considered a nonresponder.

The data collected from the ~60 questions asked include information about the household and family composition, occurrence of recent diarrheal illnesses among children younger than 5 years, and health care utilization practices. HUAS Lite contained a subset of questions from the longer HUAS survey. The HUAS questionnaire also provided an opportunity to query a representative sample of the population on their attitudes concerning diarrhea, its prevention and treatment. The survey may have been modified as appropriate for each site, while adhering to the main elements. In some countries, birth dates may not be known and it may be necessary to use an events calendar to estimate ages.

The questionnaires allowed the estimation of the ability of the sentinel health centers at each study site to capture at least 75% of the cases of moderate-to-severe diarrhea within the 7-day eligibility period. The survey also made it possible to determine the true incidence of moderate-to-severe diarrhea at the end of the study period. If the child did not experience moderate-to-severe diarrhea during the past 14 days, then parents were asked hypothetical questions about their anticipated health care utilization should their child develop such an illness. This permitted a determination of the proportion of mothers who would use the sentinel health centers if their children had an episode of moderate-to-severe diarrhea in the future.Information on the respondents' perceptions about the danger of diarrheal diseases in children, their attitudes about the importance of developing vaccines and other interventions were also collected.

Study documentation:

HUAS Questionnaire
HUAS Lite Questionnaire

Last Updated: May 6, 2021
The Global Enteric Multicenter Study (GEMS) 1 HUAS/HUAS Lite surveys were three community-based Healthcare Services Utilization and Attitudes Surveys (HUAS, HUAS lite, and HUAS lite - Kenya) conducted in conjunction with the GEMS1 case control study. These cross-sectional surveys provide data on where parents seek care when their children have diarrheal disease, and their attitudes and practices concerning diarrhea, its prevention, and treatment.