Childhood cause-specific mortality in rural Western Kenya: application of the InterVA-4 model.
BACKGROUND
Assessing the progress in achieving the United Nation's Millennium Development Goals in terms of population health requires consistent and reliable information on cause-specific mortality, which is often rare in resource-constrained countries. Health and demographic surveillance systems (HDSS) have largely used medical personnel to review and assign likely causes of death based on the information gathered from standardized verbal autopsy (VA) forms. However, this approach is expensive and time consuming, and it may lead to biased results based on the knowledge and experience of individual clinicians. We assessed the cause-specific mortality for children under 5 years old (under-5 deaths) in Siaya County, obtained from a computer-based probabilistic model (InterVA-4).


METHODS
Successfully completed VA interviews for under-5 deaths conducted between January 2003 and December 2010 in the Kenya Medical Research Institute/US Centers for Disease Control and Prevention HDSS were extracted from the VA database and processed using the InterVA-4 (version 4.02) model for interpretation. Cause-specific mortality fractions were then generated from the causes of death produced by the model.


RESULTS
A total of 84.33% (6,621) childhood deaths had completed VA data during the study period. Children aged 1-4 years constituted 48.53% of all cases, and 42.50% were from infants. A single cause of death was assigned to 89.18% (5,940) of cases, 8.35% (556) of cases were assigned two causes, and 2.10% (140) were assigned 'indeterminate' as cause of death by the InterVA-4 model. Overall, malaria (28.20%) was the leading cause of death, followed by acute respiratory infection including pneumonia (25.10%), in under-5 children over the study period. But in the first 5 years of the study period, acute respiratory infection including pneumonia was the main cause of death, followed by malaria. Similar trends were also reported in infants (29 days-11 months) and children aged 1-4 years.


CONCLUSIONS
Under-5 cause-specific mortality obtained using the InterVA-4 model is consistent with existing knowledge on the burden of childhood diseases in rural western Kenya.
Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; namek@kemricdc.org.
Nyaguara O
NO
Amek
Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
Frank O
FO
Odhiambo
Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
Sammy
S
Khagayi
Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
Hellen
H
Moige
Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
Gordon
G
Orwa
Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Mary J
MJ
Hamel
Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
Annemieke
A
Van Eijk
Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
John
J
Vulule
Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Laurence
L
Slutsker
Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Kayla F
KF
Laserson
D001344:Autopsy; D002423:Cause of Death; D002675:Child, Preschool; D003625:Data Collection / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D015233:Models, Statistical; D011159:Population Surveillance; D012424:Rural Population
InterVA; health and demographic surveillance; under-5; verbal autopsy