Abstract
BackgroundTuberculosis (TB) remains one of the key public health problems in Africa. Due to multifaceted challenges, its burden is poorly described in informal settlements. We describe tuberculosis mortality in two informal settlements in Nairobi, Kenya.MethodsThis is a secondary analysis of 2002–2016 verbal autopsy data from informal settlements in the Nairobi Urban Health Demographic Surveillance System (NUHDSS). A descriptive analysis of deaths assigned as caused by TB was done. Pearson chi-square tests were used to determine differences between socio-demographic factors. Logistic regression was carried out to examine the risk of death from TB within the characteristics.ResultsThere were 6218 deaths in the NUHDSS within the period of analysis, of which 930 (14.96%) were deaths from TB. The average number of TB deaths per year was 62(SD 23.9). There was a reduction in TB deaths from 21.2% in 2005 to 1.7% in 2016. Males had 1.39 higher odds of dying from TB than females (AOR 1.39; 95% CI 1.18–1.64; p-value < 0.001). Compared to those aged 30–39 years, the ≥50-year-olds had a 42% lower chance of dying from TB (AOR 0.57; 95% CI 0.47–0.73; p-value < 0.001). Those dying at home had 1.39 odds of dying from TB as compared to those who died in a health facility(AOR 1.93; 95% CI 1.17–1.64; p value< 0.001).ConclusionThere was a reduction in TB deaths over the study period. Males had the highest risk of death. There is a need to strengthen TB surveillance and access to TB diagnosis and treatment within informal settlements to enhance early diagnosis and treatment.
Highlights
Tuberculosis (TB) ranks as one of the top causes of morbidity and mortality globally
Study area The TB mortality data used in this paper was collected from two informal settlements (Korogocho and Viwandani) in Nairobi Kenya, that form the Nairobi Urban Health Demographic Surveillance System (NUHDSS), a demographic surveillance system run by the African population health research centre(APHRC)
Data The NUHDSS Verbal Autopsy (VA) dataset consisted of 1) responses to a questionnaire that captured events surrounding the death from the deceased person’s close relative(s) or caregiver(s) who was aware of the circumstances surrounding the death 2) the physicians’ interpretation of likely cause of death from the deceased signs and symptoms following the VA and 3) the output from the InterVA-4 software that consists of up to 3 likelihoods attributed to each death
Summary
Tuberculosis (TB) ranks as one of the top causes of morbidity and mortality globally. The global incidence of TB is estimated at an average of 130 cases per 100,000 population per year with approximately 10 million people being infected with TB in 2018 [1]. The 2019 global TB report estimates that there were approximately 1.5 million people that died of TB in 2018. Africa bears the highest global TB burden and over 50% of TB cases in the region are co-infected with HIV [2]. Kenya is ranked among the high TB burden countries. As of 2017, the estimated TB incidence was 319 cases per 100, 000 population while TB mortality was estimated at 50/100, 000 [4]. We describe tuberculosis mortality in two informal settlements in Nairobi, Kenya
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