Impact of the COVID-19 epidemic on mortality in rural coastal Kenya

Otiende, Mark; Nyaguara, Amek; Bottomley, Christian; Walumbe, David; Mochamah, George; Amadi, David; Nyundo, Christopher; Kagucia, E. Wangeci; Etyang, Anthony; Adetifa, Ifedayo; Maitha, Eric; Chondo, Elwyn; Nzomo, Eddy; Aman, Rashid; Mwangangi, Mercy; Amoth, Patrick; Kasera, Kadondi; Ng’ang’a, Wangari; Barasa, Edwine; Tsofa, Benjamin; Mwangangi, Joseph; Bejon, Philip; Agweyu, Ambrose; Williams, Tom N.; Scott, Anthony

doi:10.1101/2022.04.06.22273516

Cited by 4 publications

(4 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The population-incidence of hospital-attended paediatric snakebite has been consistently high despite substantial population growth, thus resulting in a growing burden of disease. There was a substantial fall in hospital-attended snakebite incidence in 2021, which is likely to be due to the SARS-CoV-2 pandemic dissuading people from attending hospital [16]. The population-incidence of hospital-attended paediatric snakebite rises with increasing age, and peaks at 8-11 years.…”

Section: Discussionmentioning

confidence: 99%

Paediatric snakebite in Kilifi County, Kenya: A 19-year observational study

Abouyannis

Boga

Amadi

et al. 2022

Preprint

View full text Add to dashboard Cite

Introduction Estimates suggest that one-third of snakebite cases in sub-Saharan Africa affect children. Despite children being at a greater risk of disability and death, there are limited published data describing the burden of paediatric snakebite. This study describes the clinical features, hospital management, population-incidence, and mortality of consecutive paediatric snakebite cases over a 19-year period. Methods Using the Kilifi Health and Demographic Surveillance System (KHDSS), all children with snakebite presenting to Kilifi County Hospital were identified. All cases were prospectively registered, admitted for at least 24-hours, and managed on a paediatric high dependency unit (HDU). Households within the KHDSS study area have been included in 4-monthly surveillance and verbal autopsy, enabling calculation of population-incidence and mortality. Predictors of severe local tissue damage were identified using a multivariate logistic regression analysis. Results Between 2003 and 2021, there were 19,798 admissions to the paediatric HDU, of which 619 were due to snakebite. Amongst infants (<=5-years age) the population-incidence of hospital- attended snakebite was 9.8/100,000 person-years; for children aged 6-13-years this was 26.4/100,000 person-years. The number of children attending hospital with snakebite has increased over time. Children aged 8-11 years had the highest incidence. There were six snakebite associated deaths. At admission, low haemoglobin, raised white blood cell count, and an upper limb bite-site were associated with the development of severe local tissue damage. Conclusion There is a substantial burden of disease due to paediatric snakebite and this has increased in-line with population growth. Most cases present with local rather than systemic envenoming, and many of these receive antivenom. The mortality rate was low, which may reflect the quality of care delivered on the paediatric HDU. There is an urgent need to better define the burden of paediatric snakebite across Africa, to initiate community engagement to prevent snakebites, and to improve treatments for local tissue damage.

show abstract

Section: Discussionmentioning

confidence: 99%

Paediatric snakebite in Kilifi County, Kenya: A 19-year observational study

Abouyannis

Boga

Amadi

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…The case with anaphylactic hypotension subsequently died due to this complication (Table 3). Amongst children receiving antivenom, 7 (5.9%) received subcutaneous adrenaline (as treatment, rather than prophylaxis), 19 The mean duration of hospital stay was 6.3 days (SD 17.8 days). There was an average of 195 bed-days occupied per year due to paediatric snakebite admissions.…”

Section: Hospital Managementmentioning

confidence: 99%

“…There was a substantial fall in hospital-attended snakebite incidence in 2021, which may have been caused by the SARS-CoV-2 pandemic altering health seeking behaviour [19]. One quarter of paediatric snakebite cases were given antivenom, which was most frequently indicated for local envenoming.…”

Section: Plos Neglected Tropical Diseasesmentioning

confidence: 99%

A long-term observational study of paediatric snakebite in Kilifi County, south-east Kenya

et al. 2023

View full text Add to dashboard Cite

Introduction Estimates suggest that one-third of snakebite cases in sub-Saharan Africa affect children. Despite children being at a greater risk of disability and death, there are limited published data. This study has determined the: population-incidence and mortality rate of hospital-attended paediatric snakebite; clinical syndromes of snakebite envenoming; and predictors of severe local tissue damage. Methods All children presenting to Kilifi County Hospital, Kenya with snakebite were identified through the Kilifi Health and Demographic Surveillance System (KHDSS). Cases were prospectively registered, admitted for at least 24-hours, and managed on a paediatric high dependency unit (HDU). Households within the KHDSS study area have been included in 4-monthly surveillance and verbal autopsy, enabling calculation of population-incidence and mortality. Predictors of severe local tissue damage were identified using a multivariate logistic regression analysis. Results Between 2003 and 2021, there were 19,606 admissions to the paediatric HDU, of which 584 were due to snakebite. Amongst young children (≤5-years age) the population-incidence of hospital-attended snakebite was 11.3/100,000 person-years; for children aged 6–12 years this was 29.1/100,000 person-years. Incidence remained consistent over the study period despite the population size increasing (98,967 person-years in 2006; and 153,453 person-years in 2021). Most cases had local envenoming alone, but there were five snakebite associated deaths. Low haemoglobin; raised white blood cell count; low serum sodium; high systolic blood pressure; and an upper limb bite-site were independently associated with the development of severe local tissue damage. Conclusion There is a substantial burden of disease due to paediatric snakebite, and the annual number of cases has increased in-line with population growth. The mortality rate was low, which may reflect the species causing snakebite in this region. The identification of independent predictors of severe local tissue damage can help to inform future research to better understand the pathophysiology of this important complication.

show abstract

“…There are limited studies that have used verbal autopsy data to conduct a comparison of deaths attributable to specific causes pre-and-during the COVID-19 period. A study conducted in rural coastal Kenya reported a transient reduction in deaths attributable to acute respiratory infections in 2020 [32]. A few other modelling studies, though not utilizing verbal autopsy data, have predicted significant increases in deaths due to other communicable diseases such as malaria, tuberculosis and HIV/AIDS due to the effects of the COVID-19 pandemic in sub-Saharan Africa [33][34][35].…”

Section: Plos Global Public Healthmentioning

confidence: 99%

Estimating excess mortality during the COVID-19 pandemic from a population-based infectious disease surveillance in two diverse populations in Kenya, March 2020-December 2021

Oduor,

Audi,

Kiplangat

et al. 2023

PLOS Glob Public Health

View full text Add to dashboard Cite

Robust data on the impact of the COVID-19 pandemic on mortality in Africa are relatively scarce. Using data from two well-characterized populations in Kenya we aimed to estimate excess mortality during the COVID-19 pandemic period. The mortality data arise from an ongoing population-based infectious disease surveillance (PBIDS) platform, which has been operational since 2006 in rural western Kenya (Asembo, Siaya County) and an urban informal settlement (Kibera, Nairobi County), Kenya. PBIDS participants were regularly visited at home (2–3 times a year) by field workers who collected demographic data, including deaths. In addition, verbal autopsy (VA) interviews for all identified deaths are conducted. We estimated all-cause and cause-specific mortality rates before and during the height of the COVID-19 pandemic, and we compared associated mortality rates between the periods using incidence rate ratios. Excess deaths during the COVID-19 period were also estimated by modelling expected deaths in the absence of COVID-19 by applying a negative binomial regression model on historical mortality data from January 2016. Overall and monthly excess deaths were determined using the P-score metric. Spearman correlation was used to assess whether there is a relationship between the generated P-score and COVID-19 positivity rate. The all-cause mortality rate was higher during the COVID-19 period compared to the pre-COVID-19 period in Asembo [9.1 (95% CI, 8.2–10.0) vs. 7.8 (95% CI, 7.3–8.3) per 1000 person-years of observation, pyo]. In Kibera, the all-cause mortality rate was slightly lower during the COVID-19 period compared to the pre-COVID-19 period [2.6 (95% CI, 2.2–3.2 per 1000 pyo) vs. 3.1; 95% CI, 2.7–3.4 per 1000 pyo)]. An increase in all-cause mortality was observed (incidence rate ratio, IRR, 1.16; 95% CI, 1.04–1.31) in Asembo, unlike in Kibera (IRR, 0.88; 95% CI, 0.71–1.09). The notable increase in mortality rate in Asembo was observed among persons aged 50 to 64 years (IRR, 2.62; 95% CI, 1.95–3.52), persons aged 65 years and above (5.47; 95% CI, 4.60–6.50) and among females (IRR, 1.25; 95% CI, 1.07–1.46). These age and gender differences were not observed in Kibera. We observed an increase in the mortality rate due to acute respiratory infection, including pneumonia (IRR, 1.45;95% CI, 1.03–2.04), and a reduction in the mortality rate due to pulmonary tuberculosis (IRR, 0.22; 95% CI, 0.05–0.87) among older children and adults in Asembo. There was no statistically significant change in mortality rates due to leading specific causes of death in Kibera. Overall, during the COVID-19 period observed deaths were higher than expected deaths in Asembo (P-score = 6.0%) and lower than expected in Kibera (P-score = -22.3%).Using well-characterized populations in the two diverse geographic locations, we demonstrate a heterogenous impact of the COVID-19 pandemic on all-cause and cause-specific mortality rates in Kenya. We observed more deaths than expected during the COVID-19 period in our rural site in western Kenya contrary to the urban site in Nairobi, the capital city in Kenya.

show abstract

Impact of the COVID-19 epidemic on mortality in rural coastal Kenya

Cited by 4 publications

References 34 publications

Paediatric snakebite in Kilifi County, Kenya: A 19-year observational study

Paediatric snakebite in Kilifi County, Kenya: A 19-year observational study

A long-term observational study of paediatric snakebite in Kilifi County, south-east Kenya

Estimating excess mortality during the COVID-19 pandemic from a population-based infectious disease surveillance in two diverse populations in Kenya, March 2020-December 2021

Contact Info

Product

Resources

About