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OUTCOME OF DELIVERY AND CAUSE-SPECIFIC MORTALITY AND SEVERE MORBIDITY IN EARLY INFANCY: A KENYAN DISTRICT HOSPITAL BIRTH COHORT

It has proven very difficult to determine the causes of early infant mortality and morbidity in Africa. We undertook a two-year, prospective birth cohort study in a rural Kenyan District Hospital to estimate cause-specific mortality and severe morbidity in infants too young to gain benefit from routine immunization approaches. A total of 2,359 infants eligible for the cohort were delivered. Of these, 136 (6%) were stillborn and 77 (3.5%) subsequently died. Prematurity (34%), birth asphyxia (27%), and infection (18.5%) were the predominant causes of death in the first 98 days of life, although infection accounted for 36% of all life-threatening illness episodes in the same period. The data suggest that health system constraints are likely to impede programmatic efforts to reduce early infant mortality and morbidity, and that infection prevention measures offer some promise for mortality reduction. Assessing the cost effectiveness of the latter, particularly for very specific interventions such as further maternal vaccination, will require very large trials.

Received February 22, 2003. Accepted for publication May 12, 2003.

Acknowledgments: We thank Grace Bomu, Joyce Nyiro, Prudence Masha, Patience Jefwa, Dorah Mitingi, Cellina Kahindi, Samuel Kambi, and Maureen Kibinda for their hard work during this study. In addition, we thank all the staff of the maternity unit and the mother and child health clinic at Kilifi District Hospital for their co-operation during the study. This manuscript is published with the permission of the Director of the Kenya Medical Research Institute.

Financial support: This project was supported by the Kenya Medical Research Institute and The Wellcome Trust (United Kingdom). Mike English is a Wellcome Trust Career Development Fellow in Clinical Tropical Medicine (050563).

Authors’ addresses: Mike English, Ann Muhoro, Amanda Ross, Norbert Peshu, Centre for Geographic Medicine Research–Coast, Kenya Medical Research Institute, Wellcome Trust Laboratories, PO Box 230, Kilifi, Kenya, Telephone: 254-125-22063, Fax: 254-125-22390, E-mail: menglish{at}kilifi.mimcom.net. Maurice Aluda and Sam Were, Kilifi District Hospital, P.O. Box 428, Kilifi, Kenya.

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