Burden of disease in adults admitted to hospital in a rural region of coastal Kenya: an analysis of data from linked clinical and demographic surveillance systems.
BACKGROUND
Estimates of the burden of disease in adults in sub-Saharan Africa largely rely on models of sparse data. We aimed to measure the burden of disease in adults living in a rural area of coastal Kenya with use of linked clinical and demographic surveillance data.


METHODS
We used data from 18,712 adults admitted to Kilifi District Hospital (Kilifi, Kenya) between Jan 1, 2007, and Dec 31, 2012, linked to 790,635 person-years of observation within the Kilifi Health and Demographic Surveillance System, to establish the rates and major causes of admission to hospital. These data were also used to model disease-specific disability-adjusted life-years lost in the population. We used geographical mapping software to calculate admission rates stratified by distance from the hospital.


RESULTS
The main causes of admission to hospital in women living within 5 km of the hospital were infectious and parasitic diseases (303 per 100,000 person-years of observation), pregnancy-related disorders (239 per 100,000 person-years of observation), and circulatory illnesses (105 per 100,000 person-years of observation). Leading causes of hospital admission in men living within 5 km of the hospital were infectious and parasitic diseases (169 per 100,000 person-years of observation), injuries (135 per 100,000 person-years of observation), and digestive system disorders (112 per 100,000 person-years of observation). HIV-related diseases were the leading cause of disability-adjusted life-years lost (2050 per 100,000 person-years of observation), followed by non-communicable diseases (741 per 100,000 person-years of observation). For every 5 km increase in distance from the hospital, all-cause admission rates decreased by 11% (95% CI 7–14) in men and 20% (17–23) in women. The magnitude of this decline was highest for endocrine disorders in women (35%; 95% CI 22–46) and neoplasms in men (30%; 9–45).


CONCLUSIONS
Adults in rural Kenya face a combined burden of infectious diseases, pregnancy-related disorders, cardiovascular illnesses, and injuries. Disease burden estimates based on hospital data are affected by distance from the hospital, and the amount of underestimation of disease burden differs by both disease and sex.


BACKGROUND
The Wellcome Trust, GAVI Alliance.
Anthony O
AO
Etyang
Kenneth
K
Munge
Erick W
EW
Bunyasi
Lena
L
Matata
Carolyne
C
Ndila
Sailoki
S
Kapesa
Maureen
M
Owiti
Iqbal
I
Khandwalla
Andrew J
AJ
Brent
Benjamin
B
Tsofa
Pamela
P
Kabibu
Susan
S
Morpeth
Evasius
E
Bauni
Mark
M
Otiende
John
J
Ojal
Philip
P
Ayieko
Maria D
MD
Knoll
Liam
L
Smeeth
Thomas N
TN
Williams
Ulla K
UK
Griffiths
J Anthony G
JA
Scott
D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002423:Cause of Death; D017281:Cost of Illness; D006233:Persons with Disabilities; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D019057:Quality-Adjusted Life Years; D012424:Rural Population; D012737:Sex Factors; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult