ArticleIJID regions2026
Comparable burden of severe acute respiratory illness among children and older adults in Kenya: evidence from a multi-site health utilization survey.
Article in IJID regions, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Hospital-based influenza surveillance may underestimate the population-level respiratory disease burden in sub-Saharan Africa. Previous Kenyan estimates reported severe acute respiratory illness (SARI) rates among adults aged ≥65 years that were 4-10 times lower than those among children aged <5 years. We used community health utilization survey (HUS) data to estimate national and county-level HUS-defined SARI and influenza-associated SARI episode rates in Kenya, with adjustments for geographic variation and health care-seeking behavior. Methods: Data from 21,088 participants in a 2018 HUS conducted in Nakuru, Kakamega, and Siaya counties were included in the burden analysis. Age-specific HUS-defined SARI episode rates were extrapolated geographically using relative county lower respiratory infection disability-adjusted life-year factors from the Global Burden of Disease 2016 study. Age-specific proportions of episodes with actual admission or recommendation for hospitalization were obtained from the HUS, whereas the 2014 Kenya Demographic and Health Survey provided a relative county health care-seeking modifier. Influenza attribution used all-age positivity from seven surveillance sites or assigned regional sources during 2017-2019. Point estimates used observed or central inputs; 95% uncertainty intervals were derived from 10,000 design-aware resampling and joint uncertainty iterations. Results: The national HUS-defined SARI episode rate was 3318 (95% uncertainty interval: 2477-4326) per 100,000. Rates were 7758 (5008-11,156) among children aged <2 years, 7890 (5698-10,629) among children aged 2-4 years, and 7155 (3108-12,682) among adults aged ≥65 years, producing a U-shaped age distribution. The influenza-associated SARI rate was 365 (270-493) per 100,000. Conclusion: Among households with children aged <5 years, adults aged ≥65 years had a HUS-defined SARI burden comparable in magnitude to that of young children. The directly observed HUS age pattern persisted after national extrapolation. Influenza-associated age-specific estimates showed a similar pattern but were less directly supported by age-specific surveillance data. Community HUS data also identified substantial HUS-defined SARI that was not captured by sentinel hospital admissions.
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