The burden of common infectious disease syndromes at the clinic and household level from population-based surveillance in rural and urban Kenya.
BACKGROUND
Characterizing infectious disease burden in Africa is important for prioritizing and targeting limited resources for curative and preventive services and monitoring the impact of interventions.


METHODS
From June 1, 2006 to May 31, 2008, we estimated rates of acute lower respiratory tract illness (ALRI), diarrhea and acute febrile illness (AFI) among >50,000 persons participating in population-based surveillance in impoverished, rural western Kenya (Asembo) and an informal settlement in Nairobi, Kenya (Kibera). Field workers visited households every two weeks, collecting recent illness information and performing limited exams. Participants could access free high-quality care in a designated referral clinic in each site. Incidence and longitudinal prevalence were calculated and compared using Poisson regression.


RESULTS
INCIDENCE RATES RESULTING IN CLINIC VISITATION WERE THE FOLLOWING: ALRI--0.36 and 0.51 episodes per year for children <5 years and 0.067 and 0.026 for persons ≥ 5 years in Asembo and Kibera, respectively; diarrhea--0.40 and 0.71 episodes per year for children <5 years and 0.09 and 0.062 for persons ≥ 5 years in Asembo and Kibera, respectively; AFI--0.17 and 0.09 episodes per year for children <5 years and 0.03 and 0.015 for persons ≥ 5 years in Asembo and Kibera, respectively. Annually, based on household visits, children <5 years in Asembo and Kibera had 60 and 27 cough days, 10 and 8 diarrhea days, and 37 and 11 fever days, respectively. Household-based rates were higher than clinic rates for diarrhea and AFI, this difference being several-fold greater in the rural than urban site.


CONCLUSIONS
Individuals in poor Kenyan communities still suffer from a high burden of infectious diseases, which likely hampers their development. Urban slum and rural disease incidence and clinic utilization are sufficiently disparate in Africa to warrant data from both settings for estimating burden and focusing interventions.
International Emerging Infections Program-Kenya, Centers for Disease Control and Prevention-Nairobi and Kisumu, Nairobi and Kisumu, Kenya. dfeikin@ke.cdc.gov
Daniel R
DR
Feikin
Beatrice
B
Olack
Godfrey M
GM
Bigogo
Allan
A
Audi
Leonard
L
Cosmas
Barrack
B
Aura
Heather
H
Burke
M Kariuki
MK
Njenga
John
J
Williamson
Robert F
RF
Breiman
D000328:Adult; D002648:Child; D003141:Communicable Diseases / Q000453:epidemiology*; D003967:Diarrhea; D005191:Family Characteristics; D005334:Fever; D006268:Health Facilities; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008137:Longitudinal Studies; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*
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