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Oduor C, Omwenga I, Ouma A, Mutinda R, Kiplangat S, Mogeni OD, Cosmas L, Audi A, Odongo GS, Obor D, Breiman R, Montgomery J, Agogo G, Munywoki P, Bigogo G, Verani JR. Mortality patterns over a 10-year period in Kibera, an urban informal settlement in Nairobi, Kenya, 2009-2018. Glob Health Action 2023; 16:2238428. [PMID: 37490025 PMCID: PMC10392302 DOI: 10.1080/16549716.2023.2238428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
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.
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Affiliation(s)
- Clifford Oduor
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Irene Omwenga
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Alice Ouma
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Robert Mutinda
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Samwel Kiplangat
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Ondari D Mogeni
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Epidemiology, Public Health, Implementation & Clinical Development Unit, International Vaccine Institute (IVI), Seoul, South Korea
| | - Leonard Cosmas
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Allan Audi
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - George S Odongo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David Obor
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Robert Breiman
- The Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Joel Montgomery
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - George Agogo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Patrick Munywoki
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Jennifer R Verani
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
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Opio J, Croker E, Odongo GS, Attia J, Wynne K, McEvoy M. Metabolically healthy overweight/obesity are associated with increased risk of cardiovascular disease in adults, even in the absence of metabolic risk factors: A systematic review and meta-analysis of prospective cohort studies. Obes Rev 2020; 21:e13127. [PMID: 32869512 DOI: 10.1111/obr.13127] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/07/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
Abstract
This review examined the risk of cardiovascular disease in adults with metabolically healthy overweight/obesity. A systematic review and meta-analysis using data from Medline, EMBASE, SCOPUS and Cochrane Library searched from inception up to 31st October 2019. We included prospective cohort studies of adults who are metabolically healthy or unhealthy. Outcomes were fatal and nonfatal cardiovascular events, all-cause mortality. Pooled relative risk was calculated for each outcome in populations with metabolically healthy overweight and metabolically healthy obesity using metabolically healthy normal weight as reference. A random-effects model was used for meta-analysis, and risk of bias assessment tool for nonrandomized studies assessed risk of bias within each study. Twenty-three prospective cohort studies with 4,492,723 participants were included. Cardiovascular disease risk was increased in metabolically healthy groups with overweight (RR = 1.34, CI: 1.23-1.46, n = 20, I2 = 90.3%) and obesity (RR = 1.58, CI: 1.34-1.85, n = 21, I2 = 92.2) compared with a reference group with metabolically healthy normal weight. Cardiovascular disease risk was similar irrespective of the number of risk factors used to define metabolically healthy and the risk remained in the group with no metabolic risk factors. Cardiovascular disease risk is increased in populations with overweight and obesity classified as metabolically healthy even when there were no metabolic risk factors.
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Affiliation(s)
- Jacob Opio
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Emma Croker
- Diabetes and Endocrinology, John Hunter Hospital, New Lambton Heights, Australia
| | - George S Odongo
- Department of Data Management and Statistics, Uganda Virus Research Institute, Entebbe, Uganda
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Centre for Clinical Epidemiology and Biostatistics, Level 4, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Katie Wynne
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Diabetes and Endocrinology, John Hunter Hospital, New Lambton Heights, Australia.,Centre for Clinical Epidemiology and Biostatistics, Level 4, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Mark McEvoy
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Centre for Clinical Epidemiology and Biostatistics, Level 4, Hunter Medical Research Institute, New Lambton Heights, Australia
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Hallowell BD, Carlson CM, Jacobs JR, Pomeroy M, Steinberg J, Tenforde MW, McDonald E, Foster L, Feldstein LR, Rolfes MA, Haynes A, Abedi GR, Odongo GS, Saruwatari K, Rider EC, Douville G, Bhakta N, Maniatis P, Lindstrom S, Thornburg NJ, Lu X, Whitaker BL, Kamili S, Sakthivel SK, Wang L, Malapati L, Murray JR, Lynch B, Cetron M, Brown C, Roohi S, Rotz L, Borntrager D, Ishii K, Moser K, Rasheed M, Freeman B, Lester S, Corbett KS, Abiona OM, Hutchinson GB, Graham BS, Pesik N, Mahon B, Braden C, Behravesh CB, Stewart R, Knight N, Hall AJ, Killerby ME. Severe Acute Respiratory Syndrome Coronavirus 2 Prevalence, Seroprevalence, and Exposure among Evacuees from Wuhan, China, 2020. Emerg Infect Dis 2020; 26:1998-2004. [PMID: 32620182 PMCID: PMC7454104 DOI: 10.3201/eid2609.201590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
To determine prevalence of, seroprevalence of, and potential exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among a cohort of evacuees returning to the United States from Wuhan, China, in January 2020, we conducted a cross-sectional study of quarantined evacuees from 1 repatriation flight. Overall, 193 of 195 evacuees completed exposure surveys and submitted upper respiratory or serum specimens or both at arrival in the United States. Nearly all evacuees had taken preventive measures to limit potential exposure while in Wuhan, and none had detectable SARS-CoV-2 in upper respiratory tract specimens, suggesting the absence of asymptomatic respiratory shedding among this group at the time of testing. Evidence of antibodies to SARS-CoV-2 was detected in 1 evacuee, who reported experiencing no symptoms or high-risk exposures in the previous 2 months. These findings demonstrated that this group of evacuees posed a low risk of introducing SARS-CoV-2 to the United States.
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Lamorde M, Mpimbaza A, Walwema R, Kamya M, Kapisi J, Kajumbula H, Sserwanga A, Namuganga JF, Kusemererwa A, Tasimwa H, Makumbi I, Kayiwa J, Lutwama J, Behumbiize P, Tagoola A, Nanteza JF, Aniku G, Workneh M, Manabe Y, Borchert JN, Brown V, Appiah GD, Mintz ED, Homsy J, Odongo GS, Ransom RL, Freeman MM, Stoddard RA, Galloway R, Mikoleit M, Kato C, Rosenberg R, Mossel EC, Mead PS, Kugeler KJ. A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda. Health Secur 2019; 16:S76-S86. [PMID: 30480504 DOI: 10.1089/hs.2018.0051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Global health security depends on effective surveillance for infectious diseases. In Uganda, resources are inadequate to support collection and reporting of data necessary for an effective and responsive surveillance system. We used a cross-cutting approach to improve surveillance and laboratory capacity in Uganda by leveraging an existing pediatric inpatient malaria sentinel surveillance system to collect data on expanded causes of illness, facilitate development of real-time surveillance, and provide data on antimicrobial resistance. Capacity for blood culture collection was established, along with options for serologic testing for select zoonotic conditions, including arboviral infection, brucellosis, and leptospirosis. Detailed demographic, clinical, and laboratory data for all admissions were captured through a web-based system accessible at participating hospitals, laboratories, and the Uganda Public Health Emergency Operations Center. Between July 2016 and December 2017, the expanded system was activated in pediatric wards of 6 regional government hospitals. During that time, patient data were collected from 30,500 pediatric admissions, half of whom were febrile but lacked evidence of malaria. More than 5,000 blood cultures were performed; 4% yielded bacterial pathogens, and another 4% yielded likely contaminants. Several WHO antimicrobial resistance priority pathogens were identified, some with multidrug-resistant phenotypes, including Acinetobacter spp., Citrobacter spp., Escherichia coli, Staphylococcus aureus, and typhoidal and nontyphoidal Salmonella spp. Leptospirosis and arboviral infections (alphaviruses and flaviviruses) were documented. The lessons learned and early results from the development of this multisectoral surveillance system provide the knowledge, infrastructure, and workforce capacity to serve as a foundation to enhance the capacity to detect, report, and rapidly respond to wide-ranging public health concerns in Uganda.
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Affiliation(s)
- Mohammed Lamorde
- Mohammed Lamorde, PhD, FRCP, is Head of the Department of Prevention, Care and Treatment, Infectious Diseases Institute, Kampala, Uganda. Co-senior author
| | - Arthur Mpimbaza
- Arthur Mpimbaza, MBChB, MMed, MSc, is Project Coordinator, Infectious Diseases Research Collaboration, Kampala, and Lecturer, Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala. Co-senior author
| | - Richard Walwema
- Richard Walwema, MBA, is with the Infectious Diseases Institute, Kampala
| | - Moses Kamya
- Moses Kamya, MBChB, MMed, MPH, PhD, is Professor and Chair, Makerere University School of Medicine, Kampala. Dr. Kamya is also with the Infectious Diseases Research Collaboration, Kampala
| | - James Kapisi
- James Kapisi, MBChB, MMed, MSc Epid, Infectious Diseases Research Collaboration, Kampala
| | - Henry Kajumbula
- Henry Kajumbula, MBChB, MMed, Department of Medical Microbiology, Makerere University School of Medicine, Kampala
| | - Asadu Sserwanga
- Asadu Sserwanga, MBChB, MPH, Infectious Diseases Research Collaboration, Kampala
| | | | - Abel Kusemererwa
- Abel Kusemererwa, Infectious Diseases Research Collaboration, Kampala
| | - Hannington Tasimwa
- Hannington Tasimwa, Department of Medical Microbiology, Makerere University School of Medicine, Kampala
| | - Issa Makumbi
- Issa Makumbi, MBChB, is with the Uganda Ministry of Health Public Health Emergency Operations Centre, Kampala
| | - John Kayiwa
- John Kayiwa, Uganda Virus Research Institute, Entebbe, Wakiso, Uganda
| | - Julius Lutwama
- Julius Lutwama, PhD, Uganda Virus Research Institute, Entebbe, Wakiso, Uganda
| | - Prosper Behumbiize
- Prosper Behumbiize is with the Health Information Systems Program, Kampala
| | - Abner Tagoola
- Abner Tagoola, MBChB, MMed, MSc, is with the Jinja Regional Referral Hospital Republic of Uganda Ministry of Health, Jinja, Uganda
| | - Jane Frances Nanteza
- Jane Frances Nanteza, MBChB, MMed, is with the Mubende Regional Referral Hospital, Republic of Uganda Ministry of Health, Mubende, Uganda
| | - Gilbert Aniku
- Gilbert Aniku, MBChB, MMed, is with Arua Regional Referral Hospital, Republic of Uganda Ministry of Health, Arua, Uganda
| | - Meklit Workneh
- Meklit Workneh, MD, MPH, is a Medical Microbiology Fellow, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Yukari Manabe
- Yukari Manabe, MD, is Associate Director of Global Health Research and Innovation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeff N Borchert
- Jeff N. Borchert, MS, is a Public Health Analyst, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Vance Brown
- Vance Brown, MA, is Deputy Program Director, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala, Uganda
| | - Grace D Appiah
- Grace D. Appiah, MD, MS, is a Medical Epidemiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D Mintz
- Eric D. Mintz, MD, MPH, is a Medical Epidemiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jaco Homsy
- Jaco Homsy, MD, MPH, is Program Director, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala, Uganda
| | - George S Odongo
- George S. Odongo, MPH, is a Public Health Informatics Fellow, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Raymond L Ransom
- Raymond L. Ransom is Associate Director for Informatics, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Molly M Freeman
- Molly M. Freeman, PhD, is a Microbiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robyn A Stoddard
- Robyn A. Stoddard, DVM, PhD, Microbiologists, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renee Galloway
- Renee Galloway, MLS, MPH, Microbiologists, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew Mikoleit
- Matthew Mikoleit, MS, is a Microbiologist, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cecilia Kato
- Cecilia Kato, PhD, is a Biologist, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ronald Rosenberg
- Ronald Rosenberg, ScD, is Associate Director for Science, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Eric C Mossel
- Eric C. Mossel, PhD, is a Microbiologist, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Paul S Mead
- Paul S. Mead, MD, MPH, is a Medical Officer, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Kiersten J Kugeler
- Kiersten Kugeler, PhD, MPH, is an Epidemiologist, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO
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