Kenya has strengthened population-based health data at community level over time. There are HDSS sites across seven counties within the country implementing VA. Additionally, eight Counties within Western and Nyanza regions are participating in a Malaria Vaccine Implementation Programme Evaluation (MVIPE), which is utilizing verbal autopsy at the community level to determine the effectiveness of the new vaccine among the under-five population.
The Homabay project on the other hand, also utilizes the community health strategy by having CHVs to notify and report deaths, CHAs to conduct VAs and county and sub county HMT to support VA supervision. The CHVs are assigned to visit a number of households, (about 100 to 120) and update details of each household once in every 6months in the MOH513 booklet(Community Household register). The CHAs then hold monthly meetings with CHVs at community unit level to capture updates made in the MOH513 and make an aggregated summary in the MOH 514 tool which is then submitted to the sub county HRIO for entry into DHIS2.
Kilifi Health and Demographic Surveillance Site
The project was established in 2000 by Kenya Medical Research Institute (KEMRI), the Wellcome Trust and the University of Oxford in Kilifi county. Their focus areas are routine surveillance for the HDSS study area residents; tracking inpatients care in Kilifi County Hospital from admission until discharge and tracking women during pregnancy till birth. They conduct Verbal Autopsy for all deaths that occur within the study area as part of mortality surveillance. The population under surveillance is approximately 280,000 within an area of 900km2 served by Kilifi County hospital.
Nagasaki Health and Demographic Surveillance Site
The project was established by Nagasaki University Institute of Tropical Medicine and Kenya Medical Research Institute (NUITM-KEMRI) Project. The HDSS is implemented in two sites; Mbita sub-county in Homabay County in 2008 and Kwale county in 2011. The main objective of the HDSS is to provide a platform for population-based research on relationships between diseases and socio-economic and environmental factors, and for the evaluation of disease control interventions. The conduct verbal autopsy for all deaths within the study area. Kwale site covers an area of 360km2 while Mbita site covers an area of 160km2; with an approximate population of 70,000 for each site.
Nairobi Urban Health And Demographic Surveillance site (NUHDS)
The project was established by African Population and Health Research Centre (APHRC) in 2002.Their scope is to provide a platform to investigate the long-term social, economic and health consequences of urban residence, and to serve as a primary research tool for intervention and impact evaluation studies focusing on the needs of the urban poor. The verbal autopsy component of the project was started in 2003 where it covered all deaths. It is implemented in two (2) sites; Korogocho and Viwandani slums in Nairobi County with an approximate population of 85,0000 per site each within an area of 2km2.
Malaria Vaccine Impact Program and Evaluation
This evaluation project started in 2019, and is being implemented in collaboration with Centers for Disease Control and Prevention (CDC) and the Kenya Medical Research Institute (KEMRI). The main focus is to evaluate the impact of RTS,S/AS01 on all-cause mortality in children aged 5-39 months, malaria mortality, and rate of hospitalization with malaria (as an indicator of severe malaria) and the gender-specific effect of RTS, S/AS01 on all cause child mortality. The evaluation is being carried out in eight counties in the western part of Kenya namely; Busia, Bungoma, Kakamega, Vihiga, Siaya, Kisumu, Homabay and Migori counties.
Western Kenya Health and Demographic Surveillance Site
This project is run by The KEMRI Center for Global Health and Research Health (KEMRI-CGHR) Health and Demographic Surveillance System Site (HDSS). It was founded in 2001 as a platform for collecting general demographic and health information (such as population age structure and density, fertility rates, birth and death rates, in- and out-migrations, patterns of health care access and utilization and the local economics of health care) as well as disease- or intervention-specific information. The project conducts verbal autopsy on all deaths in the demographic surveillance area. The project is implemented in: Siaya County ( Rarieda , Alego-usonga and Gem sub-counties) and Nairobi County (Kibra sub-county). In Siaya county the estimated population was 260,000 within an approximated area of 700km2 , while In Nairobi the estimated population was 32,000 within approximated area of 2.5m2
Homabay Civil Registration and Vital Statistics
This was a pilot project that was established by KEMRI/CDC in collaboration with Bloomberg philanthropies and Homabay County in 2016 to 2019. It was carried out in Rachuonyo North sub-county, serving as the first model on implementing and supporting routine Verbal Autopsy through community health strategy. The estimated population covered was 200,539 within an approximate area of 435km2
| site | Cause of death algorithm | WHO Questionnaire | Verbal Autopsy Interviewers | Area (Km2) | started | population | urban/rural | funders | collaboration |
|---|---|---|---|---|---|---|---|---|---|
| Kilifi HDSS | interva4 | who 2012 | 6 | 900 | 2000 | 280000 | semi urban | KEMRI Wellcome trust | Kilifi county government |
| Nagasaki | interva4 | who 2016 | 9 | 360 | Mbita 2008, Kwale 2011 | Kwale 70,000, Mbita 70,000 | rural | Nagasaki University, Japanese government | Kenya Medical Research Institute (KEMRI). |
| APHRC | interva4 | who 2016 | 8 | 2 | 2002 | Korogocho 85,000 , Viwandani 85,000 | urban | HDSS stakeholders | County and National government |
| MVIPE | interva5 | who 2016 | 98 | NA | 2019 | - | semi urban | WHO, Global fund, UNITAID | County and National government |
| Western Kenya HDSS | interva5 | who 2016 | 3 | 700 | 2001 | Siaya 260,000, Kibera 32,000 | Siaya - rural, Kibera Urban | CDC, Washington university, CHAMPS, London School of Hygiene and Tropical Medicine, Henry Jackson Foundation, KEMRI, HDSS stakeholders | KEMRI, CHAMPS, MVIPE |
| Homabay CRVS | interva5 | who 2016 | 35 | 435 | 2016 | Rachuonyo North 200,539 | semi urban | US CDC, CDC foundation, Bloomberge philanthropies | County and Ministry of health division of health informatics |
Collaborators and partners
