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.
Highlights
Most childhood deaths today occur in Sub-Saharan Africa, and over three-quarters of these deaths are due to infectious diseases [1]
Clinic visit rates were highest in children,5 years old (0.77 visits/person-year in Asembo, 2.4 visits/person-year in Kibera.) Clinic visit rates were higher for all age groups,35 years in Kibera than Asembo, similar in persons 35–49 years and higher in Asembo for persons $50 years
For children,5 years, illness episodes were reported during the last two weeks in 40.3% of household visits in Asembo compared with 13.7% in Kibera (RR = 2.9, 95% CI 2.9–3.0)
Summary
Most childhood deaths today occur in Sub-Saharan Africa, and over three-quarters of these deaths are due to infectious diseases [1]. Characterizing burden of infectious disease syndromes in Africa is important for targeting and prioritizing use of limited resources for optimal curative and preventive services and for research and development of novel strategies and interventions. Longitudinal surveillance of disease burden is important in monitoring impact of these public health expenditures. In Africa, the majority of cases of acute infectious illnesses do not present at health facilities [3,4], and most deaths occur at home [5]. Community-based, household surveillance can supplement facility-based surveillance to define disease burden and measure impact of public health interventions. Characterizing infectious disease burden in Africa is important for prioritizing and targeting limited resources for curative and preventive services and monitoring the impact of interventions
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