Sensitivity of hospital-based surveillance for severe disease: a geographic information system analysis of access to care in Kilifi district, Kenya

Moïsi, Jennifer C; Nokes, D. James; Gatakaa, Hellen; Williams, Thomas N.; Bauni, Evasius; Levine, Orin S.; Scott, John A.

doi:10.2471/blt.10.080796

Cited by 60 publications

(74 citation statements)

References 28 publications

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“…In a rural community with a poor transport system where subsistence farming is the major source of income, it is expected that physical access to services may have been problematic for many, resonating findings from previous research [33]. This may account for the fact that people residing in divisions closest to facilities made up the majority of caseload entries for hospital-based services.…”

Section: Discussionmentioning

confidence: 89%

Survey of rehabilitation support for children 0–15 years in a rural part of Kenya

Bunning¹,

Gona²,

Odera-Mung'ala³

et al. 2013

Disability and Rehabilitation

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Purpose: Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0-15 years) and their families in rural Kenya. Method: A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services. Results: Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods. Conclusions: The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms. ä Implications for RehabilitationThere needs to be greater investment in rehabilitation provision in developing countries. Consideration of community-based initiatives is required to support better access for all. In order to argue the case for improved resources, better skills and mechanisms for recording, monitoring and evaluating practice are needed.

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Section: Discussionmentioning

confidence: 89%

Survey of rehabilitation support for children 0–15 years in a rural part of Kenya

Bunning¹,

Gona²,

Odera-Mung'ala³

et al. 2013

Disability and Rehabilitation

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“…13 Previous data suggest that children who are discharged from hospital have a higher risk of dying during the 12-month period following discharge than comparable children in the community and that diarrhoea is a significant predictor of excess mortality. 6 In this study we sought to determine whether hospital admission could be characterized as an acute event with an impact on short-term mortality or as a marker of chronic frailty associated with an increased risk of dying over the longer term.…”

Section: Introductionmentioning

confidence: 99%

Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis

Moïsi¹,

Gatakaa²,

Berkley³

et al. 2011

Bull World Health Org

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“…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. However, disease rates were 8-fold higher in children <5 and 16-fold higher in persons ≥5 in the town of Dapaong than outside Dapaong, suggesting that distance to hospital was a major impediment to accessing care, as seen elsewhere [34]. The decline in incidence observed over the project period is another partial explanation for our low overall rates.…”

Section: Discussionmentioning

confidence: 72%

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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Sensitivity of hospital-based surveillance for severe disease: a geographic information system analysis of access to care in Kilifi district, Kenya

Cited by 60 publications

References 28 publications

Survey of rehabilitation support for children 0–15 years in a rural part of Kenya

Survey of rehabilitation support for children 0–15 years in a rural part of Kenya

Excess child mortality after discharge from hospital in Kilifi, Kenya: a retrospective cohort analysis

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

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