Trends observed during a decade of paediatric sick visits to peripheral health facilities in rural western Kenya, 1997-2006

To assess whether longitudinal surveillance in peripheral health facilities could document trends in disease burden, healthcare practice and utilization resulting from large-scale public health interventions made in the decade 1997-2006. Data were collected from sick child visits (SCVs) among children < 5 years attending 14 outpatient facilities in Asembo, rural western Kenya, during 1997-2006. Changes in proportions, and counts and rates were evaluated using chi-square and Poisson regression respectively. During the decade, 64 394 SCVs were made, yielding an average rate of 0.70 SCVs per child-year. The annual number of SCVs stayed constant during 1997-2003, then increased by 74% between 2003 and 2006 (P < 0.01). The time between symptom onset and SCV shortened from 5.6 days in 1997 to 4.4 days in 2006 (P < 0.01). Malaria and upper respiratory tract infection (URTI) were most commonly diagnosed (69% and 36% of SCVs respectively). Between 2003 and 2006, the proportion of SCVs with a malaria diagnosis fell from 77% to 48%, although the rate of malaria SCVs did not. URTI visits increased in 2004-2006. The most frequently prescribed antimalarials changed three times, lagging 1-2 years behind changes in national policy. Treatment of pneumonia with antibiotics varied by year, ranging from 19% to 89%. Surveillance of paediatric SCVs at peripheral health facilities was useful in documenting the timing and penetration of changes in national policies and clinical patterns of drug use for common infections. The surveillance data suggested that improved access to care, rather than disease burden changes, likely led to greater healthcare utilization after 2003.