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Dickens Otieno Onyango

Incidence, risk factors and interventions addressing mortality associated with HIV and TB infections among children and adults in Kenya

Academiegebouw, Utrecht University

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Reliable data on deaths from tuberculosis (TB) and human immuno-deficiency virus (HIV) are important to guide public health interventions and to improve disease control. The accuracy of estimates based on routine data from civil registration and vital statistics is challenging in low- and middle-income countries. This is related to underreporting and to errors in documentation of causes of death. This thesis provides updated estimates of TB and HIV specific mortality in Kenya based on mortality studies, expert panel determination of causes of death, and epidemiological analysis of routine surveillance data. We used innovative approaches such as postmortem HIV testing, and minimally invasive tissue sampling.

These novel approaches documented a higher-than-expected HIV prevalence in the deceased. HIV/AIDS was the leading underlying cause of death in adults and the third underlying cause of death in children aged under five. TB was 12th among the direct causes of death. Most HIV-infected decedents were virally non-suppressed.  The case fatality ratio among patients on TB treatment was 4% in children aged <15 years and 6% in adults. The case fatality ratio was 5 times higher among HIV-infected patients who were not on antiretroviral therapy than HIV-uninfected patients. Forty two percent of deaths among TB patients and 17% of deaths in the population were attributed to HIV-infection. Persistent mortality from TB and HIV is attributable to undiagnosed disease, treatment failure or inadequate access to preventive interventions.


  • Prof. dr. Marianne van der Sande (ITM)

  • Prof. dr. Rick Grobbee (Utrecht University) 

  • Dr. Courtney Yuen (Utrecht University/ Harvard Medical School Center for Global Health and Social Medicine)

  • Dr. Steve Wandiga (Utrecht University, KEMRI/CDC Kenya)

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