Burden of disease in adults admitted to hospital in a rural region of coastal Kenya: an analysis of data from linked clinical and demographic surveillance systems

Background Estimates of the burden of disease in adults in sub-Saharan Africa largely rely on models of sparse data. We aimed to measure the burden of disease in adults living in a rural area of coastal Kenya with use of linked clinical and demographic surveillance data. Methods We used data from 18 712 adults admitted to Kilifi District Hospital (Kilifi , Kenya) between Jan 1, 2007, and Dec 31, 2012, linked to 790 635 person-years of observation within the Kilifi Health and Demographic Surveillance System, to establish the rates and major causes of admission to hospital. These data were also used to model diseasespecifi c disability-adjusted life-years lost in the population. We used geographical mapping software to calculate admission rates stratifi ed by distance from the hospital. Findings The main causes of admission to hospital in women living within 5 km of the hospital were infectious and parasitic diseases (303 per 100 000 person-years of observation), pregnancy-related disorders (239 per 100 000 personyears of observation), and circulatory illnesses (105 per 100 000 person-years of observation). Leading causes of hospital admission in men living within 5 km of the hospital were infectious and parasitic diseases (169 per 100 000 personyears of observation), injuries (135 per 100 000 person-years of observation), and digestive system disorders (112 per 100 000 person-years of observation). HIV-related diseases were the leading cause of disability-adjusted lifeyears lost (2050 per 100 000 person-years of observation), followed by non-communicable diseases (741 per 100 000 personyears of observation). For every 5 km increase in distance from the hospital, all-cause admission rates decreased by 11% (95% CI 7–14) in men and 20% (17–23) in women. The magnitude of this decline was highest for endocrine disorders in women (35%; 95% CI 22–46) and neoplasms in men (30%; 9–45). Interpretation Adults in rural Kenya face a combined burden of infectious diseases, pregnancy-related disorders, cardiovascular illnesses, and injuries. Disease burden estimates based on hospital data are aff ected by distance from the hospital, and the amount of underestimation of disease burden diff ers by both disease and sex

Seropositivity of <i>Brucella</i> spp. and <i>Leptospira</i> spp. antibodies among abattoir workers and meat vendors in the city of Mwanza, Tanzania: A call for one health approach control strategies

<div><p>Introduction</p><p>Brucellosis and leptospirosis are among neglected tropical zoonotic diseases particularly in the resource limited countries. Despite being endemic in these countries, there is paucity of information on its magnitude. This study investigated seropositivity of <i>Brucella</i> spp. and <i>Leptospira</i> spp., and associated factors among abattoir workers and meat vendors in the city of Mwanza, Tanzania.</p><p>Methodology</p><p>A community based cross-sectional study was conducted in Mwanza city from May to July 2017. Socio-demographic and other relevant information were collected. Detection of <i>Brucella</i> spp. and <i>Leptospira</i> spp. antibodies were done using slide agglutination test and microscopic agglutination test, respectively. Data were analyzed using STATA version 13 Software.</p><p>Findings</p><p>A total of 250 participants (146 abattoir workers and 104 meat vendors) were enrolled with median age of 31 (IQR: 25–38) years. The overall, seropositivity of <i>Brucella</i> spp. antibodies was 48.4% (95% Cl: 42–54). Seropositivity of <i>B</i>. <i>abortus</i> was significantly higher than that of <i>B</i>. <i>melitensis</i> (46.0%, 95%Cl: 39–52 vs. 23.6%, 95% Cl: 18–28, P<0.001) while seropositivity of both species was 21.2% (95%Cl: 16–26). The seropositivity of <i>Leptospira</i> spp. was 10.0% (95% CI: 6–13) with predominance of <i>Leptospira kirschneri</i> serovar Sokoine which was detected in 7.2% of the participants. Being abattoir worker (OR: 2.19, 95% CI 1.06–4.54, p = 0.035) and long work duration (OR: 1.06, 95%CI: 1.01–1.11, p = 0.014) predicted presence of both <i>B</i>.<i>abortus</i> and <i>B</i>. <i>melitensis</i> antibodies. Only being married (p = 0.041) was significantly associated with seropositivity of <i>Leptospira</i> spp. Primary education was the only factor independently predicted presence of <i>Brucella</i> spp. antibodies among abattoir workers on sub-analysis of occupational exposure. None of factors were found to be associated with presence of <i>Brucella</i> spp. antibodies among meat vendors on sub-analysis.</p><p>Conclusion</p><p>Seropositivity of <i>B</i>.<i>abortus</i> antibodies among abattoir workers and meat vendors is high and seem to be a function of being abattoir worker, having worked for long duration in the abattoir and having primary education. In addition, a significant proportion of abattoir workers and meat vendors in the city was seropositive for <i>Leptospira kirschneri</i> serovar Sokoine. There is a need to consider ‘one health approach’ in devising appropriate strategies to control these diseases in the developing countries.</p></div

Factors associated with <i>B</i>.<i>melitensis</i> seropositivity among study participants between May and July 2017.

<p>Factors associated with <i>B</i>.<i>melitensis</i> seropositivity among study participants between May and July 2017.</p

Boxplot showing the median work duration (years) between <i>Brucella</i> spp. seropositive and seronegative participants.

<p>Boxplot showing the median work duration (years) between <i>Brucella</i> spp. seropositive and seronegative participants.</p

Sociodemographic characteristics of the study participants conducted from May to July 2017.

<p>Sociodemographic characteristics of the study participants conducted from May to July 2017.</p

Factors associated with <i>B</i>.<i>abortus</i> seropositivity among study participants between May and July 2017.

<p>Factors associated with <i>B</i>.<i>abortus</i> seropositivity among study participants between May and July 2017.</p

Seropositivity of <i>Leptospira</i> serovars among abattoir workers and meat vendors in Mwanza city.

<p>Seropositivity of <i>Leptospira</i> serovars among abattoir workers and meat vendors in Mwanza city.</p