title: Can routinely collected national data on childhood morbidity and mortality from diarrhea be used to monitor health impact of rotavirus vaccination in Africa? Examination of pre-vaccine baseline data from Rwanda.
abstract: BACKGROUND
  As rotavirus vaccine is introduced into routine childhood immunization programs in Africa, understanding its impact on diarrheal disease burden is important. The objective of this analysis was to determine whether routinely collected health information on national diarrhea hospitalizations, in-hospital deaths and outpatient visits would be useful to monitor rotavirus vaccine impact.
  
  
  METHODS
  We analyzed data for all-cause, nonbloody diarrheal disease among children <5 years of age from the routine health management information system (HMIS) in Rwanda from January 2008 through December 2011. We described trends in absolute numbers of inpatient admissions, in-hospital deaths and outpatient visits by year, age and setting.
  
  
  RESULTS
  All-cause, nonbloody diarrheal hospitalizations and outpatient visits among children <5 years of age in Rwanda from 2008 to 2011 peaked during the June to August dry season, coinciding with the rotavirus season. The bulk of the diarrheal disease burden occurred in children <1 year of age. Health centers provided many care to children with diarrhea including 60-72% of hospitalizations and 97-99% of outpatient visits. Many in-hospital diarrheal deaths (84%) occurred in district hospitals.
  
  
  CONCLUSIONS
  Given the stable and consistent trends and the prominent seasonality consistent with that of rotavirus, HMIS data should provide a useful baseline to monitor rotavirus vaccine impact on the overall diarrheal disease burden in Rwanda. Active, sentinel surveillance for rotavirus diarrhea will help interpret changes in diarrheal disease trends following vaccine introduction. Other countries planning rotavirus vaccine introduction should explore the availability and quality of their HMIS data.
authors.affiliation: From the *Rwanda Ministry of Health, Rwanda; †Université Libre de Bruxelles, Brussels, Belgium; ‡Rwanda Biomedical Center, Rugenge, Kigali, Rwanda; §Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Bruxelles, Belgium; ¶Centers for Disease Control and Prevention, Atlanta, USA; ‖World Health Organization, Regional Office for Africa, Brazzaville, Congo; **World Health Organization, Kigali, Rwanda; and ††Harvard University School of Public Health, Boston, MA.
authors.forename: Fidele
authors.initials: F
authors.lastname: Ngabo
authors.forename: Maurice
authors.initials: M
authors.lastname: Gatera
authors.forename: Corrine
authors.initials: C
authors.lastname: Karema
authors.forename: Philippe
authors.initials: P
authors.lastname: Donnen
authors.forename: Philippe
authors.initials: P
authors.lastname: Lepage
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tate
authors.forename: Jason M
authors.initials: JM
authors.lastname: Mwenda
authors.forename: Celse
authors.initials: C
authors.lastname: Rugambwa
authors.forename: Agnès
authors.initials: A
authors.lastname: Binagwaho
mesh_terms: D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D062486:Public Health Surveillance; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000517:prevention & control; D022243:Rotavirus Vaccines / Q000008:administration & dosage*; D012432:Rwanda / Q000453:epidemiology; D012621:Seasons
chemical_list: D022243:Rotavirus Vaccines