The epidemiology of hospitalized pneumonia in rural Kenya: the potential of surveillance data in setting public health priorities

Tornheim, Jeffrey A.; Manya, Ayub; Oyando, Norbert; Kabaka, Stewart; Breiman, Robert F.; Feikin, Daniel R.

doi:10.1016/j.ijid.2007.03.006

Cited by 36 publications

(35 citation statements)

References 27 publications

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“…Although it is difficult to directly compare rates of community-acquired bacteremia by using the population that presented at the hospital in the current study, based on the fact that these rates may not be representative of those in the community, one plausible explanation for the absence of Streptococcus pneumoniae-positive cultures in our study may be one of the enrollment criteria: children presenting with symptoms of respiratory tract infection, a condition commonly associated with malaria in the region, were excluded from enrollment (35).…”

Section: Discussionmentioning

confidence: 99%

Bacteremia in Kenyan Children Presenting with Malaria

et al. 2011

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Since the etiologies and clinical outcomes of bacteremia in children with Plasmodium falciparum infections, particularly in areas of holoendemic malaria transmission, are largely unexplored, blood cultures and comprehensive clinical, laboratory, hematological, and nutritional parameters for malaria-infected children (aged 1 to 36 months, n ‫؍‬ 585 patients) were investigated at a rural hospital in western Kenya. After the exclusion of contaminant microorganisms, the prevalence of bacteremia was 11.7% in the cohort (n ‫؍‬ 506), with nontyphoidal Salmonella spp. being the most common isolates (42.4%). Bacteremia was found to occur in a significantly higher proportion of females than males and was associated with elevated blood glucose concentrations and lowered malaria parasite and hemoglobin (Hb) levels compared to those in abacteremic participants. In addition, the incidences of respiratory distress and severe malarial anemia (SMA; Hb level of <6.0g/dl) were nonsignificantly greater in children with bacteremia. Mortality was 8.5-fold higher in children with bacteremia. Multivariate logistic regression analyses revealed that bacteremia was significantly associated with reduced incidences of high-density parasitemia (HDP; >10,000/l) and increased incidences of malnutrition (i.e., underweight; weight-for-age Z score of <؊2 using the NCHS system). Since previous studies showed that bacteremia caused by Gram-negative organisms is associated with enhanced anemia and mortality, multivariate logistic regression was also performed separately for randomly age-and gender-matched children with bacteremia caused by Gram-negative organisms (n ‫؍‬ 37) and for children found to be abacteremic (n ‫؍‬ 74). These results revealed that the presence of bacteremia caused by Gram-negative organisms was significantly associated with reduced HDP, enhanced susceptibility to respiratory distress, SMA (Hb level of <6.0 g/dl), and being underweight (Z score, <؊2). Data presented here from a region of holoendemic P. falciparum transmission demonstrate that although bacteremia is associated with reduced malaria parasitemia, a number of unfavorable clinical outcomes, including malnutrition, respiratory distress, anemia, and mortality, are elevated in children with bacteremia, particularly in cases of Gram-negative origin.

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Section: Discussionmentioning

confidence: 99%

Bacteremia in Kenyan Children Presenting with Malaria

et al. 2011

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“…However, it can probably be attributed, at least in part, to the relatively low levels of health-seeking for severe illness in this region of Kenya, probably attributable to cultural beliefs, the costs of health care and the large distances to the nearest health-care facilities. 15,[26][27][28] In a survey of health utilization in Bondo district in 2005, only 26% of children aged < 5 years and 16% of older children and adults were hospitalized for a reported episode of pneumonia in the previous year. 26 The observation that health-care utilization for severe illness is low in this part of Kenya is reinforced by the finding that most deaths in the area occur at home.…”

Section: Discussionmentioning

confidence: 99%

“…14 The hospital in the neighbouring district of Siaya and the provincial hospital in Kisumu are 27 and 57 km from Bondo town, respectively, and rarely admit patients from Bondo district. 15 In one part of Bondo district, 25 000 people are offered free, high-quality care at Lwak Mission Hospital, including admission, as part of population-based infectious disease surveillance. 16,17 Influenza vaccination is…”

Section: Study Sitementioning

confidence: 99%

The population-based burden of influenza-associated hospitalization in rural western Kenya, 2007–2009

Feikin

Ope

Aura

et al. 2012

Bull. World Health Organ.

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“…18 However, there is little evidence of seasonal effects on pneumonia mortality at the population level. Slum dwellers, despite their high morbidity and mortality burden, have low health care utilization rates 6,7,19 ; hence, hospital-based data may not capture the true burden of the disease or its seasonality effects, if any, among this population.…”

Section: Introductionmentioning

confidence: 99%

Seasonal Pattern of Pneumonia Mortality among Under-Five Children in Nairobi’s Informal Settlements

Yé

Zulu

Mutisya

et al. 2009

The American Journal of Tropical Medicine and Hygiene

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Abstract. Using longitudinal data from the Nairobi Urban and Demographic Surveillance System (NUHDSS), we examined the seasonal pattern of pneumonia mortality among under-five children living in Nairobi's slums. We included 17,787 under-five children resident in the NUHDSS from January 1, 2003 to December 31, 2005 in the analysis. Four hundred thirty-six deaths were observed and cause of death was ascertained by verbal autopsy for 377 of these deaths. Using Poisson regression, we modeled the quarterly mortality risk for pneumonia. The overall person-years (PYs) were 21,804 giving a mortality rate of 20.1 per 1,000 PYs in the study population. Pneumonia was the leading cause of death contributing 25.7% of the total deaths. Pneumonia mortality was highest in the second quarter (risk ratio [RR] = 2.3, confidence interval [CI]: 1.2-4.2 compared with the fourth quarter). The study provides evidence that pneumonia-related mortality among under-fives in Nairobi's slums is higher from April to June corresponding to the rainy season and the beginning of the cold season.

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The epidemiology of hospitalized pneumonia in rural Kenya: the potential of surveillance data in setting public health priorities

Cited by 36 publications

References 27 publications

Bacteremia in Kenyan Children Presenting with Malaria

Bacteremia in Kenyan Children Presenting with Malaria

The population-based burden of influenza-associated hospitalization in rural western Kenya, 2007–2009

Seasonal Pattern of Pneumonia Mortality among Under-Five Children in Nairobi’s Informal Settlements

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