The Burden of Common Infectious Disease Syndromes at the Clinic and Household Level from Population-Based Surveillance in Rural and Urban Kenya

Abstract

BackgroundCharacterizing infectious disease burden in Africa is important for prioritizing and targeting limited resources for curative and preventive services and monitoring the impact of interventions.MethodsFrom June 1, 2006 to May 31, 2008, we estimated rates of acute lower respiratory tract illness (ALRI), diarrhea and acute febrile illness (AFI) among >50,000 persons participating in population-based surveillance in impoverished, rural western Kenya (Asembo) and an informal settlement in Nairobi, Kenya (Kibera). Field workers visited households every two weeks, collecting recent illness information and performing limited exams. Participants could access free high-quality care in a designated referral clinic in each site. Incidence and longitudinal prevalence were calculated and compared using Poisson regression.ResultsIncidence rates resulting in clinic visitation were the following: ALRI — 0.36 and 0.51 episodes per year for children <5 years and 0.067 and 0.026 for persons ≥5 years in Asembo and Kibera, respectively; diarrhea — 0.40 and 0.71 episodes per year for children <5 years and 0.09 and 0.062 for persons ≥5 years in Asembo and Kibera, respectively; AFI — 0.17 and 0.09 episodes per year for children <5 years and 0.03 and 0.015 for persons ≥5 years in Asembo and Kibera, respectively. Annually, based on household visits, children <5 years in Asembo and Kibera had 60 and 27 cough days, 10 and 8 diarrhea days, and 37 and 11 fever days, respectively. Household-based rates were higher than clinic rates for diarrhea and AFI, this difference being several-fold greater in the rural than urban site.ConclusionsIndividuals in poor Kenyan communities still suffer from a high burden of infectious diseases, which likely hampers their development. Urban slum and rural disease incidence and clinic utilization are sufficiently disparate in Africa to warrant data from both settings for estimating burden and focusing interventions.

Childhood Respiratory Morbidity and Cooking Practices Among Households in a Predominantly Rural Area of Ghana

“…It could have been possible an URTI outbreak occurred at the time of this survey, but this was unlikely as there was no report of such an outbreak by health authorities in our surveyed area in the six-month period of our survey. The prevalence of respiratory symptoms determined in this survey is similar to that obtained in other surveys in rural areas of Kenya (Feikin et al, 2011), and in industrialized countries where air pollution is high (Kumar et al, 2007;Ranzi et al, 2014).…”

Access to Waterless Hand Sanitizer Improves Student Hand Hygiene Behavior in Primary Schools in Nairobi, Kenya

“…Households in this area also exhibit high rates of pneumonia and diarrheal disease. [27][28][29] All primary schools within the surveillance area were visited to obtain information on their student population as well as current water supply, sanitation, and hygiene services. Schools with more than 100 students were considered eligible for the study to ensure balance of school populations across treatment arms.…”

Molecular detection ofRickettsia felis and CandidatusRickettsia Asemboensis in Fleas from Human Habitats, Asembo, Kenya

“…This rural site on the eastern shore of Lake Victoria falls within a health and demographic surveillance system (HDSS) run by the Kenya Medical Research Institute (KEMRI) and US Centers for Disease Control and Prevention (CDC) (Adazu et al 2005). The Kenyan International Emerging Infections Program of KEMRI/CDC has conducted population-based infectious disease surveillance (PBIDS) of the human population in Asembo since late 2005 (Feikin et al 2011). The PBIDS population is approximately 25,000 people living in 33 villages.…”