Burden of disease in adults admitted to hospital in a rural region of coastal Kenya: an analysis of data from linked clinical and demographic surveillance systems

Etyang, Anthony; Munge, Kenneth; Bunyasi, Erick Wekesa; Matata, Lena; Ndila, Carolyne; Kapesa, Sailoki; Owiti, Maureen; Khandwalla, Iqbal; Brent, Andrew; Tsofa, Benjamin; Kabibu, Pamela; Morpeth, Susan; Bauni, Evasius; Otiende, Mark; Ojal, John; Ayieko, Philip; Knoll, Maria Deloria; Smeeth, Liam; Williams, Thomas N.; Griffiths, Ulla K.; Scott, John A.

doi:10.1016/s2214-109x(14)70023-3

Cited by 52 publications

(60 citation statements)

References 36 publications

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“…Kenya (population 43.2 million in 2012) is a middle-income country that is marked by a double-burden of communicable and non-communicable diseases (18) and is underrepresented in publications from SSA on HF epidemiology (8). Findings from an economically developing country in the midst of an epidemiologic transition may have local and worldwide relevance for similarly situated countries.…”

Section: Introductionmentioning

confidence: 99%

Markers of Atherosclerosis, Clinical Characteristics, and Treatment Patterns in Heart Failure: A Case-Control Study of Middle-Aged Adult Heart Failure Patients in Rural Kenya

Bloomfield

DeLong

Akwanalo

et al. 2016

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Background While risk factors for heart failure are increasingly common worldwide, the contribution of markers of atherosclerosis to heart failure in sub-Saharan Africa is largely unknown. Objectives To assess the association between atherosclerotic risk factors and heart failure in a developing country. Methods We performed a case-control study of heart failure in rural Kenya. We assess the risk factors for heart failure using international criteria based on electrocardiogram (ECG), echocardiogram, physical examination findings and laboratory testing. Atherosclerotic risk factors were determined by ECG, echocardiogram, ankle-brachial index (ABI), and lipid testing. We describe the relation of wall motion abnormalities on echocardiogram, ABI <0.9 and ischemic pattern on ECG to presence of heart failure with multivariable logistic regression adjusting for age and sex and using adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results There were 125 cases and 191 controls (n=316); 49% were male. The mean age was 60 (standard deviation 13) years. Most patients had hypertension (53%), and 16% had HIV. Lipids were in the normal range for all. Cases were older than controls (62 vs. 58 years, respectively). The most common abnormality associated with heart failure was dilated cardiomyopathy. Ischemic heart failure was the second most common in men. Cases were more likely to have an ABI <0.9 (46% vs. 31%, AOR 1.99, 95% CI 1.19–3.32), ischemia/infarct on ECG (68% vs. 43%, AOR 3.01, 95% CI 1.43–6.34), and wall motion abnormalities on echocardiogram (54% vs. 15%, AOR 7.00, 95% CI 3.95–12.39). Conclusion Ischemic heart failure is more common in Kenya than previously recognized. Non-invasive markers of atherosclerosis are routinely found among heart failure patients. Treatment and prevention of heart failure in sub-Saharan Africa must consider a wide range of causes including those related to atherosclerosis.

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Section: Introductionmentioning

confidence: 99%

Markers of Atherosclerosis, Clinical Characteristics, and Treatment Patterns in Heart Failure: A Case-Control Study of Middle-Aged Adult Heart Failure Patients in Rural Kenya

Bloomfield

DeLong

Akwanalo

et al. 2016

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“…As with children, the incidence of adult hospitalized pneumonia in our population also appeared low compared to rural African settings, though to our knowledge evidence from the region is limited to Kenya [32,33] and the low HIV prevalence in Togo could explain its lower disease burden [29]. Because the project covered the cost of hospitalization and treatment for all enrolled patients, we consider that direct medical costs were unlikely to limit access to care in our study.…”

Section: Discussionmentioning

confidence: 92%

Burden of Pneumococcal Disease in Northern Togo before the Introduction of Pneumococcal Conjugate Vaccine

Moïsi

Makawa

Tall³

et al. 2017

PLoS ONE

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BackgroundS. pneumoniae is a leading cause of meningitis morbidity and mortality in the African meningitis belt, but little is known of its contribution to the burden of pneumonia in the region. We aimed to estimate the incidence of pneumococcal disease in children and adults in northern Togo, before the introduction of pneumococcal conjugate vaccine (PCV).Methods and findingsFrom May 1st 2010 to April 30th 2013, we systematically enrolled all hospitalized patients meeting a case definition of suspected meningitis or clinical pneumonia, residing in Tone or Cinkasse districts, northern Togo and providing informed consent. We collected clinical data and tested biological specimens according to standardized procedures, including bacteriology and PCR testing of cerebro-spinal fluid for meningitis patients and blood cultures and whole blood lytA PCR for pneumonia patients. Chest X-rays (CXR) were interpreted using the WHO methodology. We included 404 patients with meningitis (104 <5 years of age) and 1550 with pneumonia (251 <5 years) over the study period. Of these, 78 (19%) had pneumococcal meningitis (13 <5 years), 574 (37%) had radiologically-confirmed pneumonia (83 <5 years) and 73 (5%) had culture-confirmed pneumococcal pneumonia (2 <5 years). PCV13 serotypes caused 79% (54/68) of laboratory-confirmed pneumococcal meningitis and 83% (29/35) of culture-confirmed pneumococcal pneumonia. Serotype 1 predominated in meningitis (n = 33) but not in pneumonia patients (n = 1). The incidence of pneumococcal disease was 7.5 per 100,000 among children <5 years of age and 14.8 in persons 5 years of age and above in the study area. When considering CXR-confirmed and blood PCR-positive pneumonia cases as likely pneumococcal, incidence estimates increased to 43.7 and 66.0 per 100,000 in each of these age groups, respectively. Incidence was at least 3-fold higher when we restricted the analysis to the urban area immediately around the study hospitals.ConclusionsOur findings highlight the important role of S. pneumoniae as a meningitis and pneumonia-causing pathogen in the African meningitis belt. Pneumococcal disease incidence in our population was substantially lower than expected from global models; we hypothesize that poor access to hospital care led us to substantially underestimate the burden of disease. Surveillance is ongoing and will enable an evaluation of PCV impact, providing novel, high quality data from the region.

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“…Although injury and HIV were not among the main reasons for visiting the health facility, other studies of the same community have shown injury and HIV as the main cause of death for young men and women, respectively 25 . Furthermore, Etyang and colleagues have reported that injuries were the most common cause of admission to Kilifi County Hospital among men, while infectious and parasitic diseases, and pregnancy-related complications were the most common among women 26 . Similarly, a review of medical causes of admission to hospital among adults in Africa reported injuries to be a leading cause of admission for men, while HIV and pregnancy-related disorders were highest among women 27 .…”

Section: Reasons For Facility Visitmentioning

confidence: 99%

Linking health facility data from young adults aged 18-24 years to longitudinal demographic data: Experience from The Kilifi Health and Demographic Surveillance System

Nyundo¹,

Doyle²,

Walumbe³

et al. 2017

Wellcome Open Res

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In 2014, a pilot study was conducted to test the feasibility of Background: linking clinic attendance data for young adults at two health facilities to the population register of the Kilifi Health and Demographic Surveillance System (KHDSS). This was part of a cross-sectional survey of health problems of young people, and we tested the feasibility of using the KHDSS platform for the monitoring of future interventions.Two facilities were used for this study. Clinical data from consenting Methods: participants aged 18-24 years were matched to KHDSS records. Data matching was achieved using national identity card numbers or otherwise using a matching algorithm based on names, sex, date of birth, location of residence and the names of other homestead members. A study form was administered to all matched patients to capture reasons for their visits and time taken to access the services. Distance to health facility from a participants' homestead was also computed.628 participated in the study: 386 (61%) at Matsangoni Health Centre, Results: and 242 (39%) at Pingilikani Dispensary. 610 (97%) records were matched to the KHDSS register. Most records (605; 96%) were matched within these health facilities, while 5 (1%) were matched during homestead follow-up visits. 463 (75.9%) of those matched were women. Antenatal care (25%), family planning (13%), respiratory infections (9%) and malaria (9%) were the main reasons for seeking care. Antenatal clinic visits (n=175) and malaria (n=27) were the commonest reasons among women and men, respectively. Participants took 1-1.5 hours to access the services; 490 (81.0%) participants lived within 5 kilometres of a facility.With a full-time research clerk at each health facility, linking Conclusions: health-facility attendance data to a longitudinal HDSS platform was feasible and could be used to monitor and evaluate the impact of health interventions on health care outcomes among young people.

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Burden of disease in adults admitted to hospital in a rural region of coastal Kenya: an analysis of data from linked clinical and demographic surveillance systems

Cited by 52 publications

References 36 publications

Markers of Atherosclerosis, Clinical Characteristics, and Treatment Patterns in Heart Failure: A Case-Control Study of Middle-Aged Adult Heart Failure Patients in Rural Kenya

Markers of Atherosclerosis, Clinical Characteristics, and Treatment Patterns in Heart Failure: A Case-Control Study of Middle-Aged Adult Heart Failure Patients in Rural Kenya

Burden of Pneumococcal Disease in Northern Togo before the Introduction of Pneumococcal Conjugate Vaccine

Linking health facility data from young adults aged 18-24 years to longitudinal demographic data: Experience from The Kilifi Health and Demographic Surveillance System

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