Identification of Streptococcus suis Meningitis through Population-Based Surveillance, Togo, 2010-2014.

During 2010-2014, we enrolled 511 patients with suspected bacterial meningitis into surveillance in 2 districts of northern Togo. We identified 15 persons with Streptococcus suis infection; 10 had occupational contact with pigs, and 12 suffered neurologic sequelae. S. suis testing should be considered in rural areas of the African meningitis belt

Association between Proximity to a Health Center and Early Childhood Mortality in Madagascar

Objective: To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance. Methods: From birth records of subjects in the Demographic and Health Survey, we identified 12565 singleton births from January 2004 to August 2009. After excluding 220 births that lacked global positioning system information for exposure assessment, odds ratios (ORs) and their 95% confidence intervals (CIs) for neonatal mortality and infant mortality were estimated using multilevel logistic regression models, with 12345 subjects (level 1), nested within 584 village locations (level 2), and in turn nested within 22 regions (level 3). We additionally stratified the subjects by the birth order. We estimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to a health center and household wealth, maternal educational attainment, and maternal anemia. Results: Compared with those who lived >1.5–3.0 km from a health center, the risks for neonatal mortality and infant mortality tended to increase among those who lived further than 5.0 km from a health center; the adjusted ORs for neonatal mortality and infant mortality for those who lived >5.0–10.0 km away from a health center were 1.36 (95% CI: 0.92–2.01) and 1.42 (95% CI: 1.06–1.90), respectively. The positive associations were more pronounced among the second or later child. The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status. Conclusions: Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality) in Madagascar by using a large-scale nationally representative dataset. The accessibility to health care in remote areas would be a key factor to achieve better infant health

Population genetic structure of Streptococcus pneumoniae in Kilifi, Kenya, prior to the introduction of pneumococcal conjugate vaccine.

BACKGROUND: The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Kenya in 2011. Introduction of any PCV will perturb the existing pneumococcal population structure, thus the aim was to genotype pneumococci collected in Kilifi before PCV10. METHODS AND FINDINGS: Using multilocus sequence typing (MLST), we genotyped >1100 invasive and carriage pneumococci from children, the largest collection genotyped from a single resource-poor country and reported to date. Serotype 1 was the most common serotype causing invasive disease and was rarely detected in carriage; all serotype 1 isolates were members of clonal complex (CC) 217. There were temporal fluctuations in the major circulating sequence types (STs); and although 1-3 major serotype 1, 14 or 23F STs co-circulated annually, the two major serotype 5 STs mainly circulated independently. Major STs/CCs also included isolates of serotypes 3, 12F, 18C and 19A and each shared ≤ 2 MLST alleles with STs that circulate widely elsewhere. Major CCs associated with non-PCV10 serotypes were predominantly represented by carriage isolates, although serotype 19A and 12F CCs were largely invasive and a serotype 10A CC was equally represented by invasive and carriage isolates. CONCLUSIONS: Understanding the pre-PCV10 population genetic structure in Kilifi will allow for the detection of changes in prevalence of the circulating genotypes and evidence for capsular switching post-vaccine implementation

Spatial and socio-demographic predictors of time-to-immunization in a rural area in Kenya: Is equity attainable?

We conducted a vaccine coverage survey in Kilifi District, Kenya in order to identify predictors of childhood immunization. We calculated travel time to vaccine clinics and examined its relationship to immunization coverage and timeliness among the 2169 enrolled children (median age: 12.5 months). 86% had vaccine cards available, >95% had received three doses of DTP-HepB-Hib and polio vaccines and 88% of measles. Travel time did not affect vaccination coverage or timeliness. The Kenyan EPI reaches nearly all children in Kilifi and delays in vaccination are few, suggesting that vaccines will have maximal impact on child morbidity and mortality

Use of linked hospital-based morbidity surveillance to explain trends in mortality in Kilifi Health and Demographic Surveillance System

Background The Kilifi Health and Demographic Surveillance System (KHDSS) is the largest population under continuous mortality surveillance in tropical Africa. Admissions to Kilifi County Hospital, the only inpatient facility in KHDSS, are linked to the KHDSS population register creating passive morbidity surveillance. We analysed the cause-specific incidence of hospital admissions and prevalence to interpret mortality trends in the KHDSS. </p

Use of linked hospital-based morbidity surveillance to explain trends in mortality in Kilifi Health and Demographic Surveillance System

<p><strong>Background</strong> The Kilifi Health and Demographic Surveillance System (KHDSS) is the largest population under continuous mortality surveillance in tropical Africa. Admissions to Kilifi County Hospital, the only inpatient facility in KHDSS, are linked to the KHDSS population register creating passive morbidity surveillance. We analysed the cause-specific incidence of hospital admissions and prevalence to interpret mortality trends in the KHDSS. </p> <p><strong>Methods</strong> We studied all deaths in children and adults and all childhood (under 5 years) admissions among residents of KHDSS from January 2004 to December 2013. We estimated mortality rates as the number of deaths divided by the person-years-at-risk (PYAR) of KHDSS residents during each study period. We used ecological regression analyses of observations from 15 locations in each of 10 years to estimate the association between admission rates and prevalence for major infectious diseases and child mortality rates.</p> <p><strong>Results</strong> Among 2,449,153 PYAR in all ages, 13,615 deaths were observed; among 450,632 PYAR in children aged under 5 years, 3592 deaths occurred (rate 8.2/1000/y). Mortality rates in children, infants and neonates declined by approximately 53% between 2004 and 2008 but remained stable subsequently. Mortality rates also declined for older children and young adults but not for individuals over 50 years of age. The admission rates of neonatal syndromes remained stable throughout the study period. Admission rates for severe malaria among infants (1-12m) and children (1-4 years) declined by 93% and 72%, respectively, between 2004 and 2008 but remained stable subsequently. By contrast, admission rates for severe pneumonia, invasive bacterial disease (IBD) and acute diarrhoeal diseases declined steadily throughout the whole period. Examining historical data from 1994-6, mortality in children aged 1-4 years fell by 89% over 20 years whilst malaria prevalence declined by 97%. In ecological analyses from 2004-2013, childhood mortality was significantly associated with both prevalence of malaria and incidence of hospitalised malaria; under-5 year mortality increased by 11·5/1000 PYAR for each 10 percentage points increase in the background prevalence of malaria.</p> <p><strong>Conclusions</strong> Mortality rates declined precipitously in children and young adults but not in those aged over 50 years. Although admission rates for most infectious diseases in children have declined steadily throughout this period, those for malaria most closely reflect the biphasic pattern of mortality reductions.</p