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Agogo GO, Munywoki PK, Audi A, Auko J, Aol G, Oduor C, Kiplangat S, Ouma A, Komo T, Herman-Roloff A, Munyua P, Bigogo G. The effect of COVID-19 pandemic on healthcare seeking in an urban informal settlement in Nairobi and a rural setting in western Kenya. PLOS Glob Public Health 2024; 4:e0002968. [PMID: 38630844 PMCID: PMC11023466 DOI: 10.1371/journal.pgph.0002968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
The COVID-19 pandemic caused widespread changes and disruptions to healthcare seeking behavior. There are limited studies on the effect of the COVID-19 pandemic on healthcare seeking patterns in low-and middle-income countries (LMICs), especially in settings with inequitable access to healthcare in rural and urban informal settlements. We investigated the effect of the COVID-19 pandemic on reported healthcare seeking at health facilities and chemists using morbidity data from participants in an ongoing population-based infectious disease surveillance platform in Asembo in Siaya County, a rural setting in western Kenya and Kibera, an urban informal settlement in Nairobi County. We described healthcare seeking patterns before (from 1st January 2016 to 12th March 2020) and during the pandemic (from 13th March 2020 to 31st August 2022) by gender and age for any reported illness and select clinical syndromes using frequencies and percentages. We used a generalized estimating equation with an exchangeable correlation structure to assess the effect of the pandemic on healthcare seeking adjusting for gender and age. Overall, there was a 19% (adjusted odds ratio, aOR: 0.81; 95% Confidence Interval, CI: 0.79-0.83) decline in odds of seeking healthcare at health facilities for any illness in Asembo during the pandemic, and a 30% (aOR: 0.70; 95% CI: 0.67-0.73) decline in Kibera. Similarly, there was a decline in seeking healthcare by clinical syndromes, e.g., for ARI, aOR: 0.76; 95% CI:0.73-0.79 in Asembo, and aOR: 0.68; 95% CI:0.64-0.72 in Kibera. The pandemic resulted in increased healthcare seeking at chemists (aOR: 1.23; 95% CI: 1.20-1.27 in Asembo, and aOR: 1.40; 95% CI: 1.35-1.46 in Kibera). This study highlights interruptions to healthcare seeking in resource-limited settings due to the COVID-19 pandemic. The pandemic resulted in a substantial decline in seeking care at health facilities, and an increase of the same at chemists.
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Affiliation(s)
- George O. Agogo
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Patrick K. Munywoki
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Allan Audi
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Joshua Auko
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - George Aol
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Clifford Oduor
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Samuel Kiplangat
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Alice Ouma
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Terry Komo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Amy Herman-Roloff
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Peninah Munyua
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Godfrey Bigogo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
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Ng'eno E, Lind M, Audi A, Ouma A, Oduor C, Munywoki PK, Agogo GO, Odongo G, Kiplangat S, Wamola N, Osita MP, Mugoh R, Ochieng C, Omballa V, Mogeni OD, Mikoleit M, Fields BS, Montgomery JM, Gauld J, Breiman RF, Juma B, Hunsperger E, Widdowson MA, Bigogo G, Mintz ED, Verani JR. Dynamic Incidence of Typhoid Fever over a 10-Year Period (2010-2019) in Kibera, an Urban Informal Settlement in Nairobi, Kenya. Am J Trop Med Hyg 2023:tpmd220736. [PMID: 37253442 DOI: 10.4269/ajtmh.22-0736] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 06/01/2023] Open
Abstract
Typhoid fever burden can vary over time. Long-term data can inform prevention strategies; however, such data are lacking in many African settings. We reexamined typhoid fever incidence and antimicrobial resistance (AMR) over a 10-year period in Kibera, a densely populated urban informal settlement where a high burden has been previously described. We used data from the Population Based Infectious Diseases Surveillance platform to estimate crude and adjusted incidence rates and prevalence of AMR in nearly 26,000 individuals of all ages. Demographic and healthcare-seeking information was collected through household visits. Blood cultures were processed for patients with acute fever or lower respiratory infection. Between 2010 and 2019, 16,437 participants were eligible for blood culture and 11,848 (72.1%) had a culture performed. Among 11,417 noncontaminated cultures (96.4%), 237 grew Salmonella enterica serovar Typhi (2.1%). Overall crude and adjusted incidences were 95 and 188 cases per 100,000 person-years of observation (pyo), respectively. Annual crude incidence varied from 144 to 233 between 2010 and 2012 and from 9 to 55 between 2013 and 2018 and reached 130 per 100,000 pyo in 2019. Children 5-9 years old had the highest overall incidence (crude, 208; adjusted, 359 per 100,000 pyo). Among isolates tested, 156 of 217 were multidrug resistant (resistant to chloramphenicol, ampicillin, and trimethoprim/sulfamethoxazole [71.9%]) and 6 of 223 were resistant to ciprofloxacin (2.7%). Typhoid fever incidence resurged in 2019 after a prolonged period of low rates, with the highest incidence among children. Typhoid fever control measures, including vaccines, could reduce morbidity in this setting.
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Affiliation(s)
- Eric Ng'eno
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Margaret Lind
- Institute for Disease Modelling, Seattle, Washington
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut
| | - Allan Audi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Alice Ouma
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Clifford Oduor
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Patrick K Munywoki
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - George O Agogo
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - George Odongo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samuel Kiplangat
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Newton Wamola
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mike Powel Osita
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Mugoh
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Caroline Ochieng
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Victor Omballa
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ondari D Mogeni
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Epidemiology, Public Health and Impact Unit, International Vaccine Institute, Seoul, South Korea
| | | | - Barry S Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel M Montgomery
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jillian Gauld
- Institute for Disease Modelling, Seattle, Washington
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bonventure Juma
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Elizabeth Hunsperger
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eric D Mintz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Hendriksen RS, Lukjancenko O, Munk P, Hjelmsø MH, Verani JR, Ng’eno E, Bigogo G, Kiplangat S, Oumar T, Bergmark L, Röder T, Neatherlin JC, Clayton O, Hald T, Karlsmose S, Pamp SJ, Fields B, Montgomery JM, Aarestrup FM. Pathogen surveillance in the informal settlement, Kibera, Kenya, using a metagenomics approach. PLoS One 2019; 14:e0222531. [PMID: 31600207 PMCID: PMC6786639 DOI: 10.1371/journal.pone.0222531] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/31/2019] [Indexed: 11/18/2022] Open
Abstract
Background Worldwide, the number of emerging and re-emerging infectious diseases is increasing, highlighting the importance of global disease pathogen surveillance. Traditional population-based methods may fail to capture important events, particularly in settings with limited access to health care, such as urban informal settlements. In such environments, a mixture of surface water runoff and human feces containing pathogenic microorganisms could be used as a surveillance surrogate. Method We conducted a temporal metagenomic analysis of urban sewage from Kibera, an urban informal settlement in Nairobi, Kenya, to detect and quantify bacterial and associated antimicrobial resistance (AMR) determinants, viral and parasitic pathogens. Data were examined in conjunction with data from ongoing clinical infectious disease surveillance. Results A large variation of read abundances related to bacteria, viruses, and parasites of medical importance, as well as bacterial associated antimicrobial resistance genes over time were detected. Significant increased abundances were observed for a number of bacterial pathogens coinciding with higher abundances of AMR genes. Vibrio cholerae as well as rotavirus A, among other virus peaked in several weeks during the study period whereas Cryptosporidium spp. and Giardia spp, varied more over time. Conclusion The metagenomic surveillance approach for monitoring circulating pathogens in sewage was able to detect putative pathogen and resistance loads in an urban informal settlement. Thus, valuable if generated in real time to serve as a comprehensive infectious disease agent surveillance system with the potential to guide disease prevention and treatment. The approach may lead to a paradigm shift in conducting real-time global genomics-based surveillance in settings with limited access to health care.
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Affiliation(s)
- Rene S. Hendriksen
- National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, Technical University of Denmark, Kgs. Lyngby, Denmark
- * E-mail:
| | - Oksana Lukjancenko
- National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Patrick Munk
- National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mathis H. Hjelmsø
- National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Jennifer R. Verani
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Eric Ng’eno
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Godfrey Bigogo
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Samuel Kiplangat
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Traoré Oumar
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Nairobi, Kenya
| | - Lasse Bergmark
- National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Timo Röder
- National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - John C. Neatherlin
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Onyango Clayton
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Tine Hald
- National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Susanne Karlsmose
- National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Sünje J. Pamp
- National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Barry Fields
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Joel M. Montgomery
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Frank M. Aarestrup
- National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, Technical University of Denmark, Kgs. Lyngby, Denmark
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