A comparison of all-cause and HIV cause-specific mortality among children under 5 years of age before and during COVID-19 in Kenya, 2018–2022

Gachau, Susan, Akelo, Victor, Cleveland, Angela, Were, Joyce, Khagayi, Sammy, Kwaro, Daniel, Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536, Obor, David, Igunza, Aggrey, Munga, Stephen, Omore, Richard, Misore, Thomas, Aol, George, Onyango, Dickens, Barr, Beth A. Tippett and Joseph, Rachael (2025) 'A comparison of all-cause and HIV cause-specific mortality among children under 5 years of age before and during COVID-19 in Kenya, 2018–2022'. PLOS Global Public Health, Vol 5, Issue 5, e0004338.

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Abstract

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.

Item Type:	Article
Subjects:	WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 506 COVID-19 WS Pediatrics > Diseases of Children and Adolescents > General Diseases > WS 200 General works
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pgph.0004338
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	28 May 2025 11:07
Last Modified:	28 May 2025 11:07
URI:	https://archive.lstmed.ac.uk/id/eprint/26684

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