| dc.description.abstract | The study seeks to determine the effect of utilization of maternal health care services on neonatal mortality in Kenya. Furthermore, the study determines the level and differentials in neonatal mortality, in Kenya. Maternal health care factors included in the study are, tetanus toxoid immunization in pregnancy, type of prenatal care provider, type of place of delivery, type of delivery assistant, timing of first prenatal care visit and the number of prenatal care visits. The study uses the 1998 Kenya Demographic and Health Survey (KDHS) data. To guide the study, specific hypotheses were developed and tested based on the conceptual framework adapted from Meegama's (1980) conceptual framework for analysing neonatal mortality in developing countries.
Logistic regression analysis was the main method of data analysis. Cross-tabulation analysis and frequency distributions were also applied in the study. Cross-tabulation analysis with chi-square test was used to determine the differentials in neonatal mortality by the various explanatory variables. Th~_1998...Kenyademographic and health survey data for 3453 children born in three years preceding the survey served as the basic data set.
Results of simple descriptive analysis indicated that 2.9% of all the live births died during the neonatal period, showing a mortality rate of 28.7 per 1000 live births. Cross tabulation analysis results indicated that among all the health care factors, tetanus toxoid injections in pregnancy and type of prenatal care provider were significantly associated with neonatal mortality. Among control variables, maternal age at birth, materngl.educational attainment, total children ever born, birth order,
type of floor material, ethnicity and size of child at birth were found to exhibit a statistically significant relationship with neonatal mortality.
The results of unadjusted effect of health care variables in multivariate analysis showed that receipt of at least two tetanus toxoid injections in pregnancy has statistically significant negative effect on neonatal mortality. After adjusting for proximate factors, receipt of at least two tetanus toxoid injections in pregnancy was found to have a statistically significant reducing effect on neonatal mortality at the 95 percent, confidence level. Children whose mothers received at least two tetanus toxoid injections in pregnancy have mortality risk estimated at about 51 percent lower than children whose mothers never received tetanus injection. Receipt of one tetanus toxoid injection in pregnancy on the other hand, has a significant suppressive effect on neonatal mortality, at the 90 percent, confidence level. The study also showed that size of child at birth had a statistically significant negative effect on neonatal mortality.
After controlling for the various socio-economic and demographic factors in the full multivariate model, receipt of at least two tetanus toxoid injections in pregnancy was established to have a significant reducing effect on neonatal mortality at the 95 percent confidence level. Children whose mothers had received the injections have mortality risk estimated at 48% lower than children whose mothers never received the tetanus injection. The effect of delivering in a health facility on neonatal mortality was found to be statistically significant at 90 percent, confidence level. Children delivered in a health facility have mortality risk of about 51 percent higher than that
of those delivered elsewhere.
The study has also indicated useful findings on the effect of other factors used in the analysis as control variables. Secondary, complete and above level of maternal educational attainment, and the average and above size of child at birth had significant protective effect on neonatal mortality while the number of children ever born and belonging to the Kamba ethnic group, showed statistically significant positive effect on neonatal mortality.
In conclusion, receipt of at least two tetanus toxoid injections in pregnancy had statistically significant effect in reducing neonatal mortality while delivery in a health facility had statistically significant positive effect on neonatal mortality. Family health programmes should, therefore, be strengthened to ensure that all pregnant women receive at least two doses of tetanus toxoid injection. Furthermore, socio economic condition of women that has been associated with use of health care services, such as place of delivery needs to be improved. Obstetric units at hospitals warrant some attention for enhanced survival chances of neonates. Finally the study demonstrates the need for further research using a more comprehensive dataset aimed at an in-depth analysis of the mechanisms through which type of place of delivery as well as other determinants operates to influence newborn survival chances. | en |
