The national burden of influenza-associated severe acute respiratory illness hospitalization in Rwanda, 2012-2014

BackgroundEstimates of influenza-associated hospitalization are severely limited in low- and middle-income countries, especially in Africa. ObjectivesTo estimate the national number of influenza-associated severe acute respiratory illness (SARI) hospitalization in Rwanda. MethodsWe multiplied the influenza virus detection rate from influenza surveillance conducted at 6 sentinel hospitals by the national number of respiratory hospitalization obtained from passive surveillance after adjusting for underreporting and reclassification of any respiratory hospitalizations as SARI during 2012-2014. The population at risk was obtained from projections of the 2012 census. Bootstrapping was used for the calculation of confidence intervals (CI) to account for the uncertainty associated with all levels of adjustment. Rates were expressed per 100000 population. A sensitivity analysis using a different estimation approach was also conducted. ResultsSARI cases accounted for 70.6% (9759/13813) of respiratory admissions at selected hospitals: 77.2% (6783/8786) and 59.2% (2976/5028) among individuals aged <5 and 5years, respectively. Overall, among SARI cases tested, the influenza virus detection rate was 6.3% (190/3022): 5.7% (127/2220) and 7.8% (63/802) among individuals aged <5 and 5years, respectively. The estimated mean annual national number of influenza-associated SARI hospitalizations was 3663 (95% CI: 2930-4395rate: 34.7; 95% CI: 25.4-47.7): 2637 (95% CI: 2110-3164rate: 168.7; 95% CI: 135.0-202.4) among children aged <5years and 1026 (95% CI: 821-1231rate: 11.3; 95% CI: 9.0-13.6) among individuals aged 5years. The estimates obtained from both approaches were not statistically different (overlapping CIs). ConclusionsThe burden of influenza-associated SARI hospitalizations was substantial and was highest among children aged <5years.