Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-7 (of 7 Records) |
Query Trace: Adazu K[original query] |
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Mortality trends from 2003 to 2009 among adolescents and young adults in rural western Kenya using a health and demographic surveillance system
Phillips-Howard PA , Odhiambo FO , Hamel M , Adazu K , Ackers M , van Eijk AM , Orimba V , Hoog AV , Beynon C , Vulule J , Bellis MA , Slutsker L , de Cock K , Breiman R , Laserson KF . PLoS One 2012 7 (11) e47017 BACKGROUND: Targeted global efforts to improve survival of young adults need information on mortality trends; contributions from health and demographic surveillance system (HDSS) are required. METHODS AND FINDINGS: This study aimed to explore changing trends in deaths among adolescents (15-19 years) and young adults (20-24 years), using census and verbal autopsy data in rural western Kenya using a HDSS. Mid-year population estimates were used to generate all-cause mortality rates per 100,000 population by age and gender, by communicable (CD) and non-communicable disease (NCD) causes. Linear trends from 2003 to 2009 were examined. In 2003, all-cause mortality rates of adolescents and young adults were 403 and 1,613 per 100,000 population, respectively, among females; and 217 and 716 per 100,000, respectively, among males. CD mortality rates among females and males 15-24 years were 500 and 191 per 100,000 (relative risk [RR] 2.6; 95% confidence intervals [CI] 1.7-4.0; p<0.001). NCD mortality rates in same aged females and males were similar (141 and 128 per 100,000, respectively; p = 0.76). By 2009, young adult female all-cause mortality rates fell 53% (chi(2) for linear trend 30.4; p<0.001) and 61.5% among adolescent females (chi(2) for linear trend 11.9; p<0.001). No significant CD mortality reductions occurred among males or for NCD mortality in either gender. By 2009, all-cause, CD, and NCD mortality rates were not significantly different between males and females, and among males, injuries equalled HIV as the top cause of death. CONCLUSIONS: This study found significant reductions in adolescent and young adult female mortality rates, evidencing the effects of targeted public health programmes, however, all-cause and CD mortality rates among females remain alarmingly high. These data underscore the need to strengthen programmes and target strategies to reach both males and females, and to promote NCD as well as CD initiatives to reduce the mortality burden amongst both gender. |
Profile: The KEMRI/CDC Health and Demographic Surveillance System--Western Kenya
Odhiambo FO , Laserson KF , Sewe M , Hamel MJ , Feikin DR , Adazu K , Ogwang S , Obor D , Amek N , Bayoh N , Ombok M , Lindblade K , Desai M , Ter Kuile F , Phillips-Howard P , van Eijk AM , Rosen D , Hightower A , Ofware P , Muttai H , Nahlen B , Decock K , Slutsker L , Breiman RF , Vulule JM . Int J Epidemiol 2012 41 (4) 977-87 The KEMRI/Centers for Disease Control and Prevention (CDC) Health and Demographic Surveillance System (HDSS) is located in Rarieda, Siaya and Gem Districts (Siaya County), lying northeast of Lake Victoria in Nyanza Province, western Kenya. The KEMRI/CDC HDSS, with approximately 220 000 inhabitants, has been the foundation for a variety of studies, including evaluations of insecticide-treated bed nets, burden of diarrhoeal disease and tuberculosis, malaria parasitaemia and anaemia, treatment strategies and immunological correlates of malaria infection, and numerous HIV, tuberculosis, malaria and diarrhoeal disease treatment and vaccine efficacy and effectiveness trials for more than a decade. Current studies include operations research to measure the uptake and effectiveness of the programmatic implementation of integrated malaria control strategies, HIV services, newly introduced vaccines and clinical trials. The HDSS provides general demographic and health information (such as population age structure and density, fertility rates, birth and death rates, in- and out-migrations, patterns of health care access and utilization and the local economics of health care) as well as disease- or intervention-specific information. The HDSS also collects verbal autopsy information on all deaths. Studies take advantage of the sampling frame inherent in the HDSS, whether at individual, household/compound or neighbourhood level. |
A reversal in reductions of child mortality in western Kenya, 2003-2009
Hamel MJ , Adazu K , Obor D , Sewe M , Vulule J , Williamson JM , Slutsker L , Feikin DR , Laserson KF . Am J Trop Med Hyg 2011 85 (4) 597-605 We report and explore changes in child mortality in a rural area of Kenya during 2003-2009, when major public health interventions were scaled-up. Mortality ratios and rates were calculated by using the Kenya Medical Research Institute/Centers for Disease Control and Prevention Demographic Surveillance System. Inpatient and outpatient morbidity and mortality, and verbal autopsy data were analyzed. Mortality ratios for children less than five years of age decreased from 241 to 137 deaths/1,000 live-births in 2003 and 2007 respectively. In 2008, they increased to 212 deaths/1,000 live-births. Mortality remained elevated during the first 8 months of 2009 compared with 2006 and 2007. Malaria and/or anemia accounted for the greatest increases in child mortality. Stock-outs of essential antimalarial drugs during a time of increased malaria transmission and disruption of services during civil unrest may have contributed to increased mortality in 2008-2009. To maintain gains in child survival, implementation of good policies and effective interventions must be complemented by reliable supply and access to clinical services and essential drugs. |
Impact of implementation of free high-quality health care on health facility attendance by sick children in rural western Kenya
Burgert CR , Bigogo G , Adazu K , Odhiambo F , Buehler J , Breiman RF , Laserson K , Hamel MJ , Feikin DR . Trop Med Int Health 2011 16 (6) 711-20 OBJECTIVES: To explore whether implementation of free high-quality care as part of research programmes resulted in greater health facility attendance by sick children. METHODS: As part of the Intermittent Preventive Treatment for Malaria in Infants (IPTi), begun in 2004, and population-based infectious disease surveillance (PBIDS), begun in 2005 in Asembo, rural western Kenya, free high-quality care was offered to infants and persons of all ages, respectively, at one Asembo facility, Lwak Hospital. We compared rates of sick-child visits by children <10 years to all seven Asembo clinics before and after implementation of free high-quality care in 10 intervention villages closest to Lwak Hospital and 8 nearby comparison villages not participating in the studies. Incidence rates and rate ratios for sick-child visits were compared between intervention and comparison villages by time period using Poisson regression. RESULTS: After IPTi began, the rate of sick-child visits for infants, the study's target group, in intervention villages increased by 191% (95% CI 75-384) more than in comparison villages, but did not increase significantly more in older children. After PBIDS began, the rate of sick-child visits in intervention villages increased by 267% (95% CI 76-661) more than that in comparison villages for all children <10 years. The greatest increases in visit rates in intervention villages occurred 3-6 months after the intervention started. Visits for cough showed greater increases than visits for fever or diarrhoea. CONCLUSIONS: Implementation of free high-quality care increased healthcare use by sick children. Cost and quality of care are potentially modifiable barriers to improving access to care in rural Africa. |
Mortality and health among internally displaced persons in western Kenya following post-election violence, 2008: novel use of demographic surveillance
Feikin DR , Adazu K , Obor D , Ogwang S , Vulule J , Hamel MJ , Laserson K . Bull World Health Organ 2010 88 (8) 601-8 OBJECTIVE: To evaluate mortality and morbidity among internally displaced persons (IDPs) who relocated in a demographic surveillance system (DSS) area in western Kenya following post-election violence. METHODS: In 2007, 204,000 individuals lived in the DSS area, where field workers visit households every 4 months to record migrations, births and deaths. We collected data on admissions among children < 5 years of age in the district hospital and developed special questionnaires to record information on IDPs. Mortality, migration and hospitalization rates among IDPs and regular DSS residents were compared, and verbal autopsies were performed for deaths. FINDINGS: Between December 2007 and May 2008, 16,428 IDPs migrated into the DSS, and over half of them stayed 6 months or longer. In 2008, IDPs aged 15-49 years died at higher rates than regular residents of the DSS (relative risk, RR: 1.34; 95% confidence interval, CI: 1.004-1.80). A greater percentage of deaths from human immunodeficiency virus (HIV) infection occurred among IDPs aged ≥ 5 years (53%) than among regular DSS residents (25-29%) (P < 0.001). Internally displaced children < 5 years of age did not die at higher rates than resident children but were hospitalized at higher rates (RR: 2.95; 95% CI: 2.44-3.58). CONCLUSION: HIV-infected internally displaced adults in conflict-ridden parts of Africa are at increased risk of HIV-related death. Relief efforts should extend to IDPs who have relocated outside IDP camps, particularly if afflicted with HIV infection or other chronic conditions. |
Geospatial distribution and determinants of child mortality in rural western Kenya 2002-2005
Ombok M , Adazu K , Odhiambo F , Bayoh N , Kiriinya R , Slutsker L , Hamel MJ , Williamson J , Hightower A , Laserson KF , Feikin DR . Trop Med Int Health 2010 15 (4) 423-33 OBJECTIVE: To describe local geospatial variation and geospatial risk factors for child mortality in rural western Kenya. METHODS: We calculated under-5 mortality rates (U5MR) in 217 villages in a Health and Demographic Surveillance System (HDSS) area in western Kenya from 1 May 2002 through 31 December 2005. U5MRs by village were mapped. Geographical positioning system coordinates of residences at the time of death and distances to nearby locations were calculated. Multivariable Poisson regression accounting for clustering at the compound level was used to evaluate the association of geospatial factors and mortality for infants and children aged 1-4 years. RESULTS: Among 54 057 children, the overall U5MR was 56.5 per 1000 person-years and varied by village from 21 to 177 per 1000 person-years. High mortality villages occurred in clusters by location and remained in the highest mortality quintile over several years. In multivariable analysis, controlling for maternal age and education as well as household crowding, higher infant mortality was associated with living closer to streams and further from public transport roads. For children 1-4 years, living at middle elevations (1280-1332 metres), living within lower population densities areas, and living in the northern section of the HDSS were associated with higher mortality. CONCLUSIONS: Childhood mortality was significantly higher in some villages. Several geospatial factors were associated with mortality, which might indicate variability in access to health care or exposure and transmission of infectious diseases. These results are useful in prioritising areas for further study and implementing directed public health interventions. |
Rotavirus disease burden and impact and cost-effectiveness of a rotavirus vaccination program in Kenya
Tate JE , Rheingans RD , O'Reilly CE , Obonyo B , Burton DC , Tornheim JA , Adazu K , Jaron P , Ochieng B , Kerin T , Calhoun L , Hamel M , Laserson K , Breiman RF , Feikin DR , Mintz ED , Widdowson MA . J Infect Dis 2009 200 S76-84 BACKGROUND: The projected impact and cost-effectiveness of rotavirus vaccination are important for supporting rotavirus vaccine introduction in Africa, where limited health intervention funds are available. METHODS: Hospital records, health utilization surveys, verbal autopsy data, and surveillance data on diarrheal disease were used to determine rotavirus-specific rates of hospitalization, clinic visits, and deaths due to diarrhea among children <5 years of age in Nyanza Province, Kenya. Rates were extrapolated nationally with use of province-specific data on diarrheal illness. Direct medical costs were estimated using record review and World Health Organization estimates. Household costs were collected through parental interviews. The impact of vaccination on health burden and on the cost-effectiveness per disability-adjusted life-year and lives saved were calculated. RESULTS: Annually in Kenya, rotavirus infection causes 19% of hospitalizations and 16% of clinic visits for diarrhea among children <5 years of age and causes 4471 deaths, 8781 hospitalizations, and 1,443,883 clinic visits. Nationally, rotavirus disease costs the health care system $10.8 million annually. Routine vaccination with a 2-dose rotavirus vaccination series would avert 2467 deaths (55%), 5724 hospitalizations (65%), and 852,589 clinic visits (59%) and would save 58 disability-adjusted life-years per 1000 children annually. At $3 per series, a program would cost $2.1 million in medical costs annually; the break-even price is $2.07 per series. CONCLUSIONS: A rotavirus vaccination program would reduce the substantial burden of rotavirus disease and the economic burden in Kenya. |
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