Mortality in Rural Coastal Kenya measured using the Kilifi Health and Demographic Surveillance System: A 16-year descriptive analysis

Abstract

Background The Kilifi Health and Demographic Surveillance System (KHDSS) was established in 2000 to define the incidence and prevalence of local diseases and evaluate the impact of community-based interventions. KHDSS morbidity data have been reported comprehensively but mortality has not been described. This analysis describes mortality in the KHDSS over 16 years. Methods We calculated mortality rates from 2003-2018 in four intervals of equal duration and assessed differences in mortality across these intervals by age and sex. We calculated the period survival function and median survival using the Kaplan-Meier method and mean life expectancies using abridged life tables. We estimated trend and seasonality by decomposing a time series of monthly mortality rates. We used choropleth maps and random effects Poisson regression to investigate geographical heterogeneity. Results Mortality declined by 36% overall between 2003-2018 and by 59% in children aged <5 years. Most of the decline occurred between 2003 and 2006. Among adults, the greatest decline (49%) was observed in those aged 15-54 years. Life expectancy at birth increased by 12 years. Females outlived males by 6 years. Seasonality was only evident in the 1-4 year age group in the first four years. Geographical variation in mortality was +/-10% of the median value and did not change over time. Conclusions Between 2003-2018 mortality among children and young adults has improved substantially. The steep decline in 2003-2006 followed by a much slower reduction thereafter suggests improvements in health and wellbeing have plateaued in the last 12 years. However, there is substantial inequality in mortality experience by geographical location.

Excess mortality in low-and lower-middle-income countries: A systematic review and meta-analysis

“…This design was however suitable at the time of the pandemic and further corresponded to WHO recommendations. 53 Estimating excess mortality requires an estimate of a certain level of baseline mortality to enable computation of excess mortality. Quanti cation of burial sites using geospatial analysis is a new method that emerged during the pandemic and was found to have considerable advantages for rapidly monitoring population mortality in settings without effective vital registrations.…”

Maternal and child surveillance in peri-urban communities: Perceptions of women and community health workers from Pakistan

“…MATLAB program reported a decrease in maternal and under 5 years mortality from 412 to 131 per 100,000 pregnancies and 59.1 to 43.5 per 1000 live births respectively [7]. The Kilifi Health and Demographic Surveillance System (KHDSS) was established in 2000 by the KEMRI-Wellcome Trust Research Program (KWTRP) which reported a reduction in under-5 mortality from 13.1 to 7.4 deaths per 1000 person-years of observation (PYO) from 2013 to 2015, with a further decline of 5.4 deaths per 1000 PYO from 2015 to 2018 [8]. These programs not only showed improvement in health outcomes but also yielded critical insights for guidelines and best practices for community-based MNCH programs [8,9].…”

“…Although, the indicators for success of CHWs in LMICs are well established (7,8), the perceptions of the communities towards them is relatively understudied. According to a study conducted in Kenya, CHWs were perceived by the community as facilitators for care seeking and health education in the community [10].…”