The epidemiology of hospitalization with diarrhea in rural Kenya: the utility of existing health facility data in developing countries

OBJECTIVES

In developing countries where prospective surveillance is resource-intensive, existing hospital data can define incidence, mortality, and risk factors that can help target interventions and track trends in disease burden.

METHODS

We reviewed hospitalizations from 2001 to 2003 at all inpatient facilities in Bondo District, Kenya.

RESULTS

Diarrhea was responsible for 11.2% (n=2158) of hospitalizations. The annual incidence was 550 and 216 per 100,000 persons aged <5 and > or =5 years, respectively. The incidence was highest in infants (1138 per 100,000 persons), decreased in older children, peaked again among 20-29-year-olds (341 per 100,000), and declined among those > or =65 years (157 per 100,000). Female adults had higher incidence than males (rate ratio=1.84, 95% CI 1.61-2.10). Incidence decreased with distance from the district referral hospital (4.5% per kilometer, p<0.0001) and from the nearest inpatient facility (6.6% per kilometer, p=0.012). Case-fatality was high (8.0%), and was higher among adults than young children. Co-diagnosis with malaria, pneumonia, HIV, and tuberculosis was common. Peak diarrhea incidence fell one to two months after heavy rains.

CONCLUSIONS

The trends revealed here provide useful data for public health priority setting and planning, including preventative interventions. The utility of such data justifies renewed efforts to establish and strengthen health management information systems in developing countries.

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

INTRODUCTION

Surveillance data from inpatient health facilities can be useful for prioritization of public health initiatives, but often are not collected or analyzed in developing countries. We evaluated data on hospitalized patients diagnosed with pneumonia in rural western Kenya to characterize pneumonia epidemiology and mortality.

METHODS

Data were obtained from admission registers of all inpatient facilities from 2001 to 2003 in Bondo District (estimated 2003 population: 255901), which is holoendemic for malaria and has high HIV rates. Inpatients with diagnoses compatible with acute pneumonia were included, and census data (1999) were used to calculate incidence rates by age, sex, season, and residence.

RESULTS

From 2001 to 2003, a total of 2466 patients diagnosed with pneumonia were hospitalized with 282 deaths (11.4%). Incidence peaked at 698 per 100,000 person-years among children <5 years of age. A second peak occurred among 20-29 year-olds at 356 per 100,000 person-years; rates were twice as high in women as men in this age group (p<0.001). The incidence in persons >65 years was 121 per 100,000 person-years. Pneumonia incidence peaked during the twice-yearly high malaria seasons, 1-2 months after peak rainfall. Rates of pneumonia decreased with increasing distance of residence from the district hospital (p<0.0001).

DISCUSSION

In Bondo District, the pneumonia burden is greatest among young children and middle-aged adults, the latter peak reflecting the area's HIV epidemic. Access to care likely influenced hospital utilization and thus pneumonia rates, particularly among the elderly. Our findings show that hospital-based data can provide useful information for public health priority setting, such as the introduction of new pneumonia vaccines for children and accelerating the introduction of antiretroviral medications.