Childhood cause-specific mortality in rural Western Kenya: application of the InterVA-4 model

Abstract

Background: Assessing the progress in achieving the United Nation's Millennium Development Goals in terms of population health requires consistent and reliable information on cause-specific mortality, which is often rare in resource-constrained countries. Health and demographic surveillance systems (HDSS) have largely used medical personnel to review and assign likely causes of death based on the information gathered from standardized verbal autopsy (VA) forms. However, this approach is expensive and time consuming, and it may lead to biased results based on the knowledge and experience of individual clinicians. We assessed the cause-specific mortality for children under 5 years old (under-5 deaths) in Siaya County, obtained from a computer-based probabilistic model (InterVA-4). Design: Successfully completed VA interviews for under-5 deaths conducted between January 2003 and December 2010 in the Kenya Medical Research Institute/US Centers for Disease Control and Prevention HDSS were extracted from the VA database and processed using the InterVA-4 (version 4.02) model for interpretation. Cause-specific mortality fractions were then generated from the causes of death produced by the model. Results: A total of 84.33% (6,621) childhood deaths had completed VA data during the study period. Children aged 1Á4 years constituted 48.53% of all cases, and 42.50% were from infants. A single cause of death was assigned to 89.18% (5,940) of cases, 8.35% (556) of cases were assigned two causes, and 2.10% (140) were assigned 'indeterminate' as cause of death by the InterVA-4 model. Overall, malaria (28.20%) was the leading cause of death, followed by acute respiratory infection including pneumonia (25.10%), in under-5 children over the study period. But in the first 5 years of the study period, acute respiratory infection including pneumonia was the main cause of death, followed by malaria. Similar trends were also reported in infants (29 daysÁ11 months) and children aged 1Á4 years. Conclusions: Under-5 cause-specific mortality obtained using the InterVA-4 model is consistent with existing knowledge on the burden of childhood diseases in rural western Kenya.

Cause-specific mortality in the Kombewa health and demographic surveillance systems site, rural Western Kenya from 2011–2015

“…Among these, HIV/AIDS, malaria, p0077neumonia and PTB were found to be the leading causes of death in all age groups (see Table 3). Our results are largely consistent with expectations and with similar studies conducted in rural Kenya, such as the in the KEMRI/CDC-Kisumu HDSS [24]. As anticipated, we found a slight excess of deaths among males (2677; 51.5%) in comparison to females (2519; 48.5%).…”

Under-five mortality in the Rongo Sub-County of Migori County, Kenya: Experience of the Lwala Community Alliance 2007-2017 with evidence from a cross-sectional survey

“…Data from rural western Kenya suggest that malaria, acute respiratory infection, anemia, and diarrhea are the most common causes of death in children under five [ 32 , 33 ]. These are consistent with data from international studies of childhood mortality and regional studies on the most common causes of child hospitalization [ 3 , 33 , 34 ].…”

Under-five mortality rate variation between the Health and Demographic Surveillance System (HDSS) and Demographic and Health Survey (DHS) approaches

“…The high under-five mortality rate in Kisumu compared to the DHS under-five mortality rate could be explained by the high prevalence of malaria in the area. Some reports show that malaria is the leading cause of child mortality in Kisumu [30, 31]. The disruption of health services in Kisumu during the post-election period in 2008 would also have increased child mortality rates [30].…”

“…Some reports show that malaria is the leading cause of child mortality in Kisumu [30, 31]. The disruption of health services in Kisumu during the post-election period in 2008 would also have increased child mortality rates [30]. On the other hand, the Agincourt HDSS is located in one of the HIV prevalent areas in South Africa and has experienced mortality shock during 1990–2000 from HIV/AIDS causing an increase in child mortality rate than the DHS reports [32–34].…”