Causes of death among persons of all ages within the Kilifi Health and Demographic Surveillance System, Kenya, determined from verbal autopsies interpreted using the InterVA-4 model

Ndila, Carolyne; Bauni, Evasius; Mochamah, George; Nyirongo, Vysaul; Makazi, Alex; Kosgei, Patrick; Tsofa, Benjamin; Nyutu, Gideon; Etyang, Anthony; Byass, Peter; Williams, Thomas N.

doi:10.3402/gha.v7.25593

Cited by 26 publications

(36 citation statements)

References 33 publications

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“…Road traffic accidents, accounted for 23.5% (68/289) of all external causes of death (see Table 4). This result is consistent with findings from the Kilifi HDSS, which found transport accidents to be the leading cause of external deaths [29]. The high numbers of traffic accidents in Kombewa and Kilifi might be explained by the popularity of motorcycles as a means of transport.…”

Section: Discussionsupporting

confidence: 90%

Cause-specific mortality in the Kombewa health and demographic surveillance systems site, rural Western Kenya from 2011–2015

Sifuna

Otieno

Ogwang

et al. 2018

Global Health Action

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Background: The vast majority of deaths in the health and Kombewa demographic surveillance system (HDSS) study area are not registered and reported through official systems of vital registration. As a result, few data are available regarding causes of death in this population. Objectives: To describe causes of death among residents of all ages in the Kombewa HDSS, located in rural Western Kenya. Methods: Verbal autopsy (VA) interviews at the site were conducted using the modified 2007 and later 2012 standardized WHO questionnaires. Assignment of causes of death was made using the InterVA-4 model version 4.02. Cox regression model, adjusted for sex, was built to evaluate the influence of age on mortality. Results: There were a total of 5196 deaths recorded between 2011 and 2015 at the site. VA interviews were successfully completed for 3903 of these deaths (75.1%). Mortality rates were highest among neonates HR = 38.54 (<0.001) and among Infants HR = 2.07 (<0.006) in the Kombewa HDSS. Among those deaths in which VA was performed, the top causes of death were HIV/AIDS (12.6%), Malaria (10.3%), Pneumonia (10.1%), Acute abdomen (7.0%), Stroke (5.2%) and TB (4.9%) for the whole population in general. Stroke, acute abdomen heart diseases and Pneumonia were common causes of death (CODs) among the elderly over the age of 65. Conclusions: The analysis established the main CODs among people of all ages within the area served by the Kombewa HDSS. We hope that information generated from this study will help better address preventable deaths in the surveyed community as well as help mitigate negative health impacts in other rural communities throughout the Western Kenya region.

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Section: Discussionsupporting

confidence: 90%

Cause-specific mortality in the Kombewa health and demographic surveillance systems site, rural Western Kenya from 2011–2015

Sifuna

Otieno

Ogwang

et al. 2018

Global Health Action

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“…Kenya ranks 146th out of 188 ranked countries in terms of human development index, and 36% of the population lives in multidimensional poverty 16. Life expectancy at birth is 62 years and leading causes of death in older adults are neoplasms, stroke, pulmonary tuberculosis and cardiac diseases 17. Two rural districts were included in the catchment area of the two collaborating health clinics.…”

Section: Methodsmentioning

confidence: 99%

Community-based screening for cardiovascular risk using a novel mHealth tool in rural Kenya

Mannik

Figol²,

Churchill

et al. 2018

BMJ Health Care Inform

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BackgroundAn increasing burden of cardiovascular disease (CVD) in low-resource settings demands innovative public health approaches.ObjectivesTo design and test a novel mobile health (mHealth) tool for use by community health workers (CHWs) to identify individuals at high CVD risk who would benefit from education and/or pharmacologic interventions.MethodsWe designed and implemented a novel two-way mobile phone application, ‘AFYACHAT’, to rapidly screen for the CVD risk in rural Kenya. AFYACHAT collects and stores a short message system (SMS) text message data entered by a CHW on a subject’s age, sex, smoking, diabetes and systolic blood pressure, and returns as SMS text message the category of 10-year CVD risk: ‘GREEN’ (<10% 10 year risk of cardiovascular event), ‘YELLOW’ (from 10% to <20%), ‘ORANGE’ (from 20% to <30%), or ‘RED’ (≥30%). CHWs were equipped and trained to use an automated blood pressure device and the mHealth tool.ResultsFive CHWs screened 2865 subjects in remote rural communities in Kenya over a 22-month period (2015–2017). The median age of subjects was 50 (interquartile range 43–60) and 1581 (55%) were female. The point prevalence of hypertension (systolic blood pressure > 140 mmHg), diabetes and tobacco use were 23%, 3.2% and 22%, respectively. Overall, the 10-year risk of CVD among patients was <10% in 2778 (97%) patients, from 10% to <20% in 65 (2.3%), from 20% to <30% in 12 (0.4%) and ≥30% in 10 (0.2%).ConclusionsWe have developed a mHealth tool that can be used by CHWs to screen for CVD risk factors, demonstrating the proof of concept in rural Kenya.

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“…18 Verbal autopsies have been done in the KHDSS since 2008. 19 If a participant died before 2008, we could not determine the causes of death. For this study, either the guardian or the carer of the deceased individual before death was interviewed within 1-4 months after the participant's death to allow for a culturally acceptable period of mourning.…”

Section: Follow-up Of Study Participants and Measurement Of Mortalitymentioning

confidence: 99%

“…Putative causes of death were assigned according to the 10th version of the International Classification of Diseases (ICD-10) using the InterVA-4 computer-based probabilistic model, as in previous studies. 9,19…”

Section: Follow-up Of Study Participants and Measurement Of Mortalitymentioning

confidence: 99%

Premature mortality in children aged 6–9 years with neurological impairments in rural Kenya: a cohort study

Abuga

Kariuki

Kinyanjui

et al. 2019

The Lancet Global Health

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Background Neurological impairments might significantly contribute to reduced life expectancy in low-income and middle-income countries (LMICs). There are no empirical studies of premature mortality in children with neurological impairments in Africa. This study estimated the risk of premature mortality in children with neurological impairments and identified risk factors and causes of death. Methods We did a cohort study based on a two-stage epidemiological survey in the Kilifi Health and Demographic Surveillance System (Kilifi, Kenya). Study participants were children aged 6-9 years. In the first stage, five trained field workers administered a low-cost screening tool to a random sample of households. In the second stage, we assessed for neurological impairments in five domains (epilepsy, cognitive impairments, vision impairments, hearing impairments, and motor impairments) using comprehensive clinical evaluation and extensive neuropsychological assessments. From the two-stage survey we identified a cohort of children with neurological impairment and a cohort of matched controls. We also enrolled an age-matched sample from the general population. The primary outcome was all-cause mortality. Mortality rates, standardised mortality ratio (SMR), and hazard ratios (HR) for risk factors were estimated and causes of death identified. Findings We enrolled 306 children with neurological impairment, 9912 survey controls, and 22 873 age-matched participants from the general population, and followed up the cohorts between June 1, 2001, and Aug 31, 2018. Median follow-up was 14•5 years (IQR 8•6-17•2). 11 (3•9%) of 284 children with neurological impairment, 92 (1•0%) of 9009 controls, and 272 (1•2%) of 22 873 participants in the general population sample died during the follow-up. Overall mortality rates were 309•8 per 100 000 person-years of observation (95% CI 126•7-492•9) in children with neurological impairment, 80•8 per 100 000 person-years of observation (64•3-97•3) in controls, and 98•8 per 100 000 person-years of observation (87•1-110•6) in the general population sample (mortality rate ratio 3•83, 95% CI 2•05-7•16, p<0•001, compared with controls; 3•13, 1•71-5•72, p<0•001, compared with the general population). Mortality risk in children with neurological impairment was not dependent on the severity of impairment (p=0•291) nor on a specific neurological impairment domain (p=0•205). The overall risk of death adjusted for age and sex was higher in children with neurological impairment compared with controls (HR 4•24, 95% CI 2•26-7•94, p=0•002). An SMR of 3•15 (95% CI 1•66-5•49) was obtained after using the general population sample as the reference for indirect standardisation. In multivariable risk factor analysis, developmental delay (adjusted HR 18•92, 95% CI 2•23-160•44, p=0•007) and severe malnutrition (20•92, 3•14-139•11, p=0•002) increased the risk of mortality in children with neurological impairment. Infections such as HIV/AIDS and accidents were common among all decedents. Interpretation The risk of prematur...

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Causes of death among persons of all ages within the Kilifi Health and Demographic Surveillance System, Kenya, determined from verbal autopsies interpreted using the InterVA-4 model

Cited by 26 publications

References 33 publications

Cause-specific mortality in the Kombewa health and demographic surveillance systems site, rural Western Kenya from 2011–2015

Cause-specific mortality in the Kombewa health and demographic surveillance systems site, rural Western Kenya from 2011–2015

Community-based screening for cardiovascular risk using a novel mHealth tool in rural Kenya

Premature mortality in children aged 6–9 years with neurological impairments in rural Kenya: a cohort study

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