The epidemiology of hospitalization with diarrhea in rural Kenya: the utility of existing health facility data in developing countries

Objectives: In developing countries where prospective surveillance is resource-intensive, existing hospital data can define incidence, mortality, and risk factors that can help target interventions and track trends in disease burden. Methods: We reviewed hospitalizations from 2001 to 2003 at all inpatient facilities in Bondo District, Kenya. Results: Diarrhea was responsible for 11.2% (n = 2158) of hospitalizations. The annual incidence was 550 and 216 per 100 000 persons aged <5 and ≥5 years, respectively. The incidence was highest in infants (1138 per 100 000 persons), decreased in older children, peaked again among 20-29-year-olds (341 per 100 000), and declined among those ≥65 years (157 per 100 000). Female adults had higher incidence than males (rate ratio = 1.84, 95% CI 1.61-2.10). Incidence decreased with distance from the district referral hospital (4.5% per kilometer, p < 0.0001) and from the nearest inpatient facility (6.6% per kilometer, p = 0.012). Case-fatality was high (8.0%), and was higher among adults than young children. Co-diagnosis with malaria, pneumonia, HIV, and tuberculosis was common. Peak diarrhea incidence fell one to two months after heavy rains. Conclusions: The trends revealed here provide useful data for public health priority setting and planning, including preventative interventions. The utility of such data justifies renewed efforts to establish and strengthen health management information systems in developing countries.