Mortality patterns over a 10-year period in Kibera, an urban informal settlement in Nairobi, Kenya, 2009-2018

• Type of Material: Article
• Authors: Clifford Oduor, Kenya Medical Research Institute (KEMRI); Irene Omwenga, Kenya Medical Research Institute (KEMRI); Alice Ouma, Kenya Medical Research Institute (KEMRI); Robert Mutinda, Kenya Medical Research Institute (KEMRI); Samwel Kiplangat, Kenya Medical Research Institute (KEMRI); Ondari D Mogeni, Kenya Medical Research Institute (KEMRI); Leonard Cosmas, Kenya Medical Research Institute (KEMRI); Allan Audi, Kenya Medical Research Institute (KEMRI); George S Odongo, Centers for Disease Control and Prevention, Atlanta; David Obor, Kenya Medical Research Institute (KEMRI); Robert Breiman, Emory University; Joel Montgomery, Centers for Disease Control and Prevention, Atlanta; George Agogo, Centers for Disease Control and Prevention, Nairobi; Patrick Munywoki, Centers for Disease Control and Prevention, Nairobi; Godfrey Bigogo, Kenya Medical Research Institute (KEMRI); Jennifer R Verani, Centers for Disease Control and Prevention, Atlanta
• Language: English
• Date: 2023-12-31
• Publisher: TAYLOR & FRANCIS LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1080/16549716.2023.2238428
• Title of Journal or Parent Work: GLOBAL HEALTH ACTION
• Volume: 16
• Issue: 1
• Start Page: 2238428
• End Page: 2238428
• Grant/Funding Information: Funding for this study was provided by the US Centers for Disease Control and Prevention, Division of Global Health Protection, Center for Global Health through various Cooperative agreements with Kenya Medical Research Institute.
• Keywords: Kenya; HOUSEHOLD AIR-POLLUTION; Science & Technology; urban informal settlements; HEALTH; Public, Environmental & Occupational Health; Mortality rate; >; cause of death; Life Sciences & Biomedicine; Kibera
• Research Categories: Engineering, Environmental; Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background: Reliable mortality data are important for evaluating the impact of health interventions. However, data on mortality patterns among populations living in urban informal settlements are limited. Objectives: To examine the mortality patterns and trends in an urban informal settlement in Kibera, Nairobi, Kenya, Methods: Using data from a population-based surveillance platform we estimated overall and cause-specific mortality rates for all age groups using person-year-observation (pyo) denominators and using Poisson regression tested for trends in mortality rates over time. We compared associated mortality rates across groups using incidence rate ratios (IRR). Assignment of probable cause(s) of death was done using the InterVA-4 model. Results: We registered 1134 deaths from 2009 to 2018, yielding a crude mortality rate of 4.4 (95% Confidence Interval [CI]4.2–4.7) per 1,000 pyo. Males had higher overall mortality rates than females (incidence rate ratio [IRR], 1.44; 95% CI, 1.28–1.62). The highest mortality rate was observed among children aged < 12 months (41.5 per 1,000 pyo; 95% CI 36.6–46.9). All-cause mortality rates among children < 12 months were higher than that of children aged 1–4 years (IRR, 8.5; 95% CI, 6.95–10.35). The overall mortality rate significantly declined over the period, from 6.7 per 1,000 pyo (95% CI, 5.7–7.8) in 2009 to 2.7 (95% CI, 2.0–3.4) per 1,000 pyo in 2018. The most common cause of death was acute respiratory infections (ARI)/pneumonia (18.1%). Among children < 5 years, the ARI/pneumonia deaths rate declined significantly over the study period (5.06 per 1,000 pyo in 2009 to 0.61 per 1,000 pyo in 2018; p = 0.004). Similarly, death due to pulmonary tuberculosis among persons 5 years and above significantly declined (0.98 per 1,000 pyo in 2009 to 0.25 per 1,000 pyo in 2018; p = 0.006). Conclusions: Overall and some cause-specific mortality rates declined over time, representing important public health successes among this population.