Gachau Susan, Akelo Victor, Cleveland Angela, Were Joyce, Khagayi Sammy, Kwaro Daniel, Taegtmeyer Miriam, Obor David, Igunza Aggrey, Munga Stephen, Omore Richard, Misore Thomas, Aol George, Onyango Dickens, Barr Beth A Tippett, Joseph Rachael
Division of Global HIV&TB (DGHT), Global Health Center, US Centers for Disease Control and Prevention (CDC), Kisumu, Kenya.
Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
PLOS Glob Public Health. 2025 May 7;5(5):e0004338. doi: 10.1371/journal.pgph.0004338. eCollection 2025.
The impact of the COVID-19 pandemic on pediatric mortality, including measures to ensure continuity of HIV care, is not well described in Kenya. We evaluated causes of death (COD) among decedents under 5 years of age both before and during the COVID-19 pandemic in Kenya. We analyzed Child Health and Mortality Prevention Surveillance (CHAMPS) data collected in February 2018-March 2022. We describe the proportional contribution of specific conditions in the causal chain of death among decedents aged 28 days to 59 months who underwent minimally invasive tissue (MITS) sampling, had an HIV polymerase chain reaction, and a COD determination. We also calculated all-cause and HIV cause-specific mortality rates using data from two health and demographic surveillance system (HDSS) sites in western Kenya. Results were stratified by time periods: February 2018 to February 2020, and March 2020 to March 2022. Among 269 MITS-eligible decedents, 55.8% died during the pre-COVID period. Of these, 53.7% were infants (28 days to 11 months), and 9.7% were HIV-positive. Leading causes of death for infants included malnutrition (20.5%), pneumonia (17.5%), sepsis (17.1%), and malaria (14.5%). For older children (12-59 months), the predominant causes were malaria (25.6%), malnutrition (21.1%), pneumonia (14.1%), and sepsis (13.1%). All-cause mortality rates did not differ significantly between the periods (53.9 vs. 52.8 per 1,000 live births, p=0.77), but HIV cause-specific mortality rates were significantly lower during March 2020-March 2022 compared to February 2018-February 2020 (1.2 vs. 3.1 per 1,000 live births, p=0.01). Malaria, malnutrition, pneumonia, and sepsis were the leading COD among decedents aged 28 days to 59 months enrolled in CHAMPS between February 2018 and March 2022. These findings may point to the need for urgent, focused efforts to prevent avoidable child deaths. Continued monitoring of HIV-related mortality could provide insights into the ongoing impact of the HIV program in the region.
在肯尼亚，新冠疫情对儿童死亡率的影响，包括确保艾滋病毒护理连续性的措施，尚未得到充分描述。我们评估了肯尼亚新冠疫情之前和期间5岁以下儿童的死因。我们分析了2018年2月至2022年3月收集的儿童健康与死亡率预防监测（CHAMPS）数据。我们描述了在接受微创组织（MITS）采样、进行艾滋病毒聚合酶链反应并确定死因的28天至59个月大儿童的死亡因果链中，特定病症的比例贡献。我们还利用肯尼亚西部两个健康与人口监测系统（HDSS）站点的数据，计算了全因死亡率和艾滋病毒特定病因死亡率。结果按时间段分层：2018年2月至2020年2月，以及2020年3月至2022年3月。在269名符合MITS标准的死者中，55.8%在新冠疫情之前死亡。其中，53.7%为婴儿（28天至11个月），9.7%为艾滋病毒阳性。婴儿的主要死因包括营养不良（20.5%）、肺炎（17.5%）、败血症（17.1%）和疟疾（14.5%）。对于大龄儿童（12 - 59个月），主要死因是疟疾（25.6%）、营养不良（21.1%）、肺炎（14.1%）和败血症（13.1%）。两个时间段的全因死亡率没有显著差异（每1000例活产分别为53.9和52.8，p = 0.77），但2020年3月至2022年3月期间的艾滋病毒特定病因死亡率显著低于2018年2月至2020年2月（每1000例活产分别为1.2和3.1，p = 0.01）。2018年2月至2022年3月期间，在CHAMPS登记的28天至59个月大儿童中，疟疾、营养不良、肺炎和败血症是主要死因。这些发现可能表明需要采取紧急、有针对性的努力来预防可避免的儿童死亡。持续监测艾滋病毒相关死亡率可以深入了解该地区艾滋病毒项目的持续影响。
