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CSU 43/2011: BURDEN OF COMMON INFECTIOUS DISEASE IN RURAL AND URBAN KENYA

Wednesday, 9th of February 2011 Print
 
 
Is the slum less unhealthful than the countryside?
 
Use of the same tools in rural and to urban slum settings permits an epidemiological comparison of infectious disease burden in town and country. In general, Kenyan rural populations in these samples had a heavier disease burden than in Kibera, Kenya's largest slum.
 
From the text:
 
'For children <5 years, illness episodes were reported during the last two weeks in 40.3% of household visits in [rural] Asembo compared with 13.7% in [urban slum] Kibera (RR = 2.9, 95% CI 2.9–3.0). For persons 5 years and over, illness episodes were reported during the last two weeks in 28% of household visits in Asembo compared with 5.1% in Kibera (RR = 5.4, 95% CI 5.4–5.5).'
 
So why do millions of Africans move into giant slums? Could it be because life there is less unhealthy than in the countryside? From an epidemiological perspective, the move to town fromcountry may be a logical choice, even when, as in Kibera, the town dwelling is not officially recognized by the state.
 
 
Abstract

Background:

Characterizing infectious disease burden in Africa is important for prioritizing and targeting limited resources for curative and preventive services and monitoring the impact of interventions.

Methods:

From June 1, 2006 to May 31, 2008,we estimated rates of acute lower respiratory tract illness (ALRI), diarrhea and acute febrile illness (AFI) among .50,000 persons participating in population-based surveillance in impoverished, rural western Kenya (Asembo) and an informal settlement in Nairobi, Kenya (Kibera). Field workers visited households every two weeks, collecting recent illness information and performing limited exams. Participants could access free high-quality care in a designated referral clinic in each site. Incidence and longitudinal prevalence were calculated and compared using Poisson regression.
 
Results:

Incidence rates resulting in clinic visitation were the following: ALRI — 0.36 and 0.51 episodes per year for children <5 years and 0.067 and 0.026 for persons >=5 years in Asembo and Kibera, respectively; diarrhea — 0.40 and 0.71 episodes per year for children <5 years and 0.09 and 0.062 for persons >=5 years in Asembo and Kibera, respectively; AFI — 0.17 and 0.09 episodes per year for children <5 years and 0.03 and 0.015 for persons >=5 years in Asembo and Kibera, respectively.

 

Annually, based on household visits, children <5 years in Asembo and Kibera had 60 and 27 cough days, 10 and 8 diarrhea days, and 37 and 11 fever days, respectively. Household-based rates were higher than clinic rates for diarrhea and AFI, this difference being several-fold greater in the rural than urban site.

Conclusions:

Individuals in poor Kenyan communities still suffer from a high burden of infectious diseases, which likely hampers their development. Urban slum and rural disease incidence and clinic utilization are sufficiently disparate in Africa to warrant data from both settings for estimating burden and focusing interventions.

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