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university of tampere: faculty of social sciences: research: research groups: epidemiology:
Faculty of Social SciencesUniversity of TampereFaculty of Social Sciences

Richard Omore, MSc
Collaborators: Kenya Medical Research Institute, Centers for Disease Control and Prevention, Kenya (CDC/KEMRI).


The burden of diarrheal diseases among children <5 years in western Kenya, 2008-2011

Few studies  have quantitatively evaluated healthcare seeking behavior among caretakers of young children with diarrheal disease in Kenya. Characterization of potential pathogens associated with diarrhea among young children from regions with highest burden of disease in the country is also rare. However, where data exist, there are notable deficiencies, including study periods that do not take into consideration seasonality patterns, non-standardized methods which would not allow population inference, and an unclear denominator for the population under study, which would be useful to estimate disease incidence and to monitor  seasonality and epidemiologic trends. In 2008, the Kenya Medical Research Institute (KEMRI) and Centers for Disease Control and Prevention (CDC) collaboration (KEMRI-CDC) began clinic-based surveillance for diarrheal disease in rural western Kenya,   which included testing stools for children <5 years presenting to clinic with moderate to severe diarrheal (MSD) illness (cases) and age-matched healthy children (controls) seen at home as part of the Global Enterics Multicenter Study (GEMS). In addition to Kenya http://www.cdc.gov/globalhealth/stories/diarrhea_kenya.html , there are 6 other sites, including 3 in Africa (Mali, The Gambia, and Mozambique), and 3 in Asia (Bangladesh, India and Pakistan). http://medschool.umaryland.edu/GEMS/default.asp.  The study focuses on burden of disease; diarrheal pathogen incidence rates are calculated using the number of children residing within the study areas, and the pathogen-specific attributable fraction based on the proportion of stool specimens from children with MSD who have a pathogen isolated from stool compared with that proportion from stool specimens of healthy children, http://hinarilogin.research4life.org/uniquesigwww.ncbi.nlm.nih.gov/uniquesig0/pubmed/23680352.

A follow-up home visit at 60-days following enrollment, also allows burden calculations to include duration of illness, sequelae and death. The GEMS Kenya protocol is implemented on a platform of an existing Health and demographic surveillance system (HDSS) operated by KEMRI-CDC. As part of GEMS activity and using HDSS as a platform, we conducted an initial extensive  Health Care Services Utilization and Attitudes Cross-sectional Survey (HUAS) and followed up with a condensed short version  of HUAS abbreviated as HUAS_lite repeated 2-3 times a year along with the HDSS census rounds described above. By performing a one-time extensive baseline cross-sectional survey on healthcare utilization and attitude (HUAS) among caretakers of children <5years and repeating a short version of the survey  (HUAS_lite) 2-3 times a year to monitor trend , we will be able to characterize HUAS patterns in these communities. By analyzing data from the HUAS, HUAS_lite and case-control sub-studies, we will then be able to make reliable estimates of the burden of diarrheal diseases (diarrhea prevalence, incidence, risk factors and healthcare seeking patterns by child age and by sex) in these communities.

 
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