Public health determinants of child malaria mortality: a surveillance study within Siaya County, Western Kenya

Thomas Hollowell; Maquins Odhiambo Sewe; Joacim Rocklöv; David Obor; Frank Odhiambo; Clas Ahlm

doi:10.1186/s12936-023-04502-9

Public health determinants of child malaria mortality: a surveillance study within Siaya County, Western Kenya

Malar J. 2023 Feb 23;22(1):65. doi: 10.1186/s12936-023-04502-9.

Authors

Thomas Hollowell^{1

2}, Maquins Odhiambo Sewe^{3

4}, Joacim Rocklöv^{4

5}, David Obor³, Frank Odhiambo³, Clas Ahlm⁶

Affiliations

¹ Department of Clinical Microbiology, Infection and Immunology, Umeå University, Umeå, Sweden. thomas.nisser.hollowell@regionvarmland.se.
² Department of Infectious Diseases, Karlstad Central Hospital, Region Värmland, Karlstad, Sweden. thomas.nisser.hollowell@regionvarmland.se.
³ KEMRI Centre for Global Health Research, Kisumu, Kenya.
⁴ Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden.
⁵ Heidelberg Institute of Global Health and Interdisciplinary Center for Scientific Computing, University of Heidelberg, Heidelberg, Germany.
⁶ Department of Clinical Microbiology, Infection and Immunology, Umeå University, Umeå, Sweden.

Abstract

Background: Malaria deaths among children have been declining worldwide during the last two decades. Despite preventive, epidemiologic and therapy-development work, mortality rate decline has stagnated in western Kenya resulting in persistently high child malaria morbidity and mortality. The aim of this study was to identify public health determinants influencing the high burden of malaria deaths among children in this region.

Methods: A total of 221,929 children, 111,488 females and 110,441 males, under the age of 5 years were enrolled in the Kenya Medical Research Institute/Center for Disease Control Health and Demographic Surveillance System (KEMRI/CDC HDSS) study area in Siaya County during the period 2003-2013. Cause of death was determined by use of verbal autopsy. Age-specific mortality rates were computed, and cox proportional hazard regression was used to model time to malaria death controlling for the socio-demographic factors. A variety of demographic, social and epidemiologic factors were examined.

Results: In total 8,696 (3.9%) children died during the study period. Malaria was the most prevalent cause of death and constituted 33.2% of all causes of death, followed by acute respiratory infections (26.7%) and HIV/AIDS related deaths (18.6%). There was a marked decrease in overall mortality rate from 2003 to 2013, except for a spike in the rates in 2008. The hazard of death differed between age groups with the youngest having the highest hazard of death HR 6.07 (95% CI 5.10-7.22). Overall, the risk attenuated with age and mortality risks were limited beyond 4 years of age. Longer distance to healthcare HR of 1.44 (95% CI 1.29-1.60), l ow maternal education HR 3.91 (95% CI 1.86-8.22), and low socioeconomic status HR 1.44 (95% CI 1.26-1.64) were all significantly associated with increased hazard of malaria death among children.

Conclusions: While child mortality due to malaria in the study area in Western Kenya, has been decreasing, a final step toward significant risk reduction is yet to be accomplished. This study highlights residual proximal determinants of risk which can further inform preventive actions.

Keywords: Child mortality; Children; Demographic surveillance; Epidemiological monitoring; Malaria; Public health.

MeSH terms

Cause of Death
Child
Child Mortality*
Child, Preschool
Female
Humans
Infant
Kenya / epidemiology
Malaria* / epidemiology
Male
Population Surveillance