Can routinely collected national data on childhood morbidity and mortality from diarrhea be used to monitor health impact of rotavirus vaccination in Africa? Examination of pre-vaccine baseline data from Rwanda.

BACKGROUND: As rotavirus vaccine is introduced into routine childhood immunization programs in Africa, understanding its impact on diarrheal disease burden is important. The objective of this analysis was to determine whether routinely collected health information on national diarrhea hospitalizations, in-hospital deaths and outpatient visits would be useful to monitor rotavirus vaccine impact. METHODS: We analyzed data for all-cause, nonbloody diarrheal disease among children <5 years of age from the routine health management information system (HMIS) in Rwanda from January 2008 through December 2011. We described trends in absolute numbers of inpatient admissions, in-hospital deaths and outpatient visits by year, age and setting. RESULTS: All-cause, nonbloody diarrheal hospitalizations and outpatient visits among children <5 years of age in Rwanda from 2008 to 2011 peaked during the June to August dry season, coinciding with the rotavirus season. The bulk of the diarrheal disease burden occurred in children