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Objective To describe local geospatial variation and geospatial risk factors for child mortality in rural western Kenya. Methods We calculated under-5 mortality rates (U5MR) in 217 villages in a Health and Demographic Surveillance System (HDSS) area in western Kenya from 1 May 2002 through 31 December 2005. U5MRs by village were mapped. Geographical positioning system coordinates of residences at the time of death and distances to nearby locations were calculated. Multivariable Poisson regression accounting for clustering at the compound level was used to evaluate the association of geospatial factors and mortality for infants and children aged 1–4 years. Results Among 54 057 children, the overall U5MR was 56.5 per 1000 person-years and varied by village from 21 to 177 per 1000 person-years. High mortality villages occurred in clusters by location and remained in the highest mortality quintile over several years. In multivariable analysis, controlling for maternal age and education as well as household crowding, higher infant mortality was associated with living closer to streams and further from public transport roads. For children 1–4 years, living at middle elevations (1280–1332 metres), living within lower population densities areas, and living in the northern section of the HDSS were associated with higher mortality. Conclusions Childhood mortality was significantly higher in some villages. Several geospatial factors were associated with mortality, which might indicate variability in access to health care or exposure and transmission of infectious diseases. These results are useful in prioritising areas for further study and implementing directed public health interventions. [ABSTRACT FROM AUTHOR]

Objective To investigate the seasonal pattern of overall mortality among children aged below 5 years living in two informal settlements in Nairobi City. Methods We used data collected from January 2003 to December 2005 in the Nairobi Urban Health and Demographic Surveillance System on demographic events (birth, death, and migration). Analyses of seasonal effects on under-five mortality are based on Poisson regression controlling for sex, age, study site and calendar year. Results During the study period, there were 17 878 children below 5 years in the study sites. Overall 436 under-five deaths were recorded. The overall death rate for the under-five children was 19.95 per 1 000 person years. There is a significant seasonal variation of under-five mortality. The mortality risk was significantly higher in the second and third quarters of year than in the fourth quarter (RR = 1.6, CI: 1.3–2.2 and RR = 1.5, CI: 1.1–2.0). Conclusion This paper demonstrates that overall mortality among under-five children in the urban poor is seasonal. Overall during the second quarter of the year, the death rate increases by nearly twofold. This evidence generated here may help to support well targeted interventions in reducing under-five mortality in the slums. [ABSTRACT FROM AUTHOR]

Objectives To assess whether longitudinal surveillance in peripheral health facilities could document trends in disease burden, healthcare practice and utilization resulting from large-scale public health interventions made in the decade 1997–2006. Methods Data were collected from sick child visits (SCVs) among children <5 years attending 14 outpatient facilities in Asembo, rural western Kenya, during 1997–2006. Changes in proportions, and counts and rates were evaluated using chi-square and Poisson regression respectively. Results During the decade, 64 394 SCVs were made, yielding an average rate of 0.70 SCVs per child-year. The annual number of SCVs stayed constant during 1997–2003, then increased by 74% between 2003 and 2006 ( P < 0.01). The time between symptom onset and SCV shortened from 5.6 days in 1997 to 4.4 days in 2006 ( P < 0.01). Malaria and upper respiratory tract infection (URTI) were most commonly diagnosed (69% and 36% of SCVs respectively). Between 2003 and 2006, the proportion of SCVs with a malaria diagnosis fell from 77% to 48%, although the rate of malaria SCVs did not. URTI visits increased in 2004–2006. The most frequently prescribed antimalarials changed three times, lagging 1–2 years behind changes in national policy. Treatment of pneumonia with antibiotics varied by year, ranging from 19% to 89%. Conclusion Surveillance of paediatric SCVs at peripheral health facilities was useful in documenting the timing and penetration of changes in national policies and clinical patterns of drug use for common infections. The surveillance data suggested that improved access to care, rather than disease burden changes, likely led to greater healthcare utilization after 2003. [ABSTRACT FROM AUTHOR]

Objectives (1) To determine whether mortality rates were raised in sick children in the 30 days after visiting first-level health facilities in an area under demographic surveillance in western Kenya, (2) to identify the types of illnesses associated with increased mortality and (3) to estimate the effectiveness of appropriate treatment. Methods All sick children (2–59 months of age) who attended one of the seven participating first-level health facilities from May to August 2003 were identified. A standardized mortality ratio was computed to compare their mortality rate in the 30 days after a sick visit with that of the community under active demographic and health surveillance. A multivariate Cox Proportional Hazards model was used to identify illnesses associated with death and to estimate the protective effectiveness of appropriate treatment for potentially life-threatening diseases. Results A total of 1383 eligible children made 1697 sick visits; 33 (2.4%) died within 30 days. Compared with children 2–59 months in the general population, sick children had a 5.3 times greater mortality rate [95% confidence interval (CI) 3.8–7.5]. In a multivariate survival analysis, significant risk factors for mortality included age <24 months [Hazard Ratio (HR) 4.4, 95% CI 1.5–12.6], malnutrition (HR 15.5, 95% CI 6.1–39.8), severe pneumonia (HR 12.9, 95% CI 3.0–56.4) and anaemia (HR 3.3, 95% CI 1.5–7.2). Appropriate treatment for a child’s most severe illness reduced mortality by 78% (95% CI 57–89%). Conclusion We estimate that improvements in diagnosis and appropriate treatment at first-level health facilities for children 2–59 months could reduce overall under-5 mortality in the area by 12–14%. [ABSTRACT FROM AUTHOR]