Mortality trends observed in population-based surveillance of an urban slum settlement, Kibera, Kenya, 2007-2010.
BACKGROUND
We used population based infectious disease surveillance to characterize mortality rates in residents of an urban slum in Kenya.


METHODS
We analyzed biweekly household visit data collected two weeks before death for 749 cases who died during January 1, 2007 to December 31, 2010. We also selected controls matched by age, gender and having a biweekly household visit within two weeks before death of the corresponding case and compared the symptoms reported.


RESULTS
The overall mortality rate was 6.3 per 1,000 person years of observation (PYO) (females: 5.7; males: 6.8). Infant mortality rate was 50.2 per 1000 PYOs, and it was 15.1 per 1,000 PYOs for children <5 years old. Poisson regression indicates a significant decrease over time in overall mortality from (6.0 in 2007 to 4.0 in 2010 per 1000 PYOs; p<0.05) in persons ≥ 5 years old. This decrease was predominant in females (7.8 to 5.7 per 1000 PYOs; p<0.05). Two weeks before death, significantly higher prevalence for cough (OR = 4.7 [95% CI: 3.7-5.9]), fever (OR = 8.1 [95% CI: 6.1-10.7]), and diarrhea (OR = 9.1 [95% CI: 6.4-13.2]) were reported among participants who died (cases) when compared to participants who did not die (controls). Diarrhea followed by fever were independently associated with deaths (OR = 14.4 [95% CI: 7.1-29.2]), and (OR = 11.4 [95% CI: 6.7-19.4]) respectively.


CONCLUSIONS
Despite accessible health care, mortality rates are high among people living in this urban slum; infectious disease syndromes appear to be linked to a substantial proportion of deaths. Rapid urbanization poses an increasing challenge in national efforts to improve health outcomes, including reducing childhood mortality rates. Targeting impoverished people in urban slums with effective interventions such as water and sanitation interventions are needed to achieve national objectives for health.
Kenya Medical Research Institute and Centers for Disease Control and Prevention Collaboration (KEMRI-CDC), Nairobi, Kenya.
Beatrice
B
Olack
Global Disease Detection Division, Kenya Office of the US Centers for Disease Control & Prevention, Nairobi, Kenya.
Daniel R
DR
Feikin
Global Disease Detection Division, Kenya Office of the US Centers for Disease Control & Prevention, Nairobi, Kenya.
Leonard O
LO
Cosmas
Kenya Medical Research Institute and Centers for Disease Control and Prevention Collaboration (KEMRI-CDC), Nairobi, Kenya.
Kennedy O
KO
Odero
Kenya Medical Research Institute and Centers for Disease Control and Prevention Collaboration (KEMRI-CDC), Nairobi, Kenya.
George O
GO
Okoth
Global Disease Detection Division, Kenya Office of the US Centers for Disease Control & Prevention, Nairobi, Kenya.
Joel M
JM
Montgomery
Global Disease Detection Division, Kenya Office of the US Centers for Disease Control & Prevention, Nairobi, Kenya.
Robert F
RF
Breiman
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011204:Poverty Areas; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult