| dc.description.abstract | Kenya experienced an upsurge in infant and child mortality during the 1988 to 2003
period.The factors underlying this upturn are poorly understood. A better understanding
of these factors is critical in designing appropriate child survival programs and strategies
for the reduction of infant and child mortality as envisioned in major national and
international public health programmes. This study established whether the observed
upsurge in infant and child mortality during the 1988-2003 was real and if so, the extent
to which it increased. Secondly, it identified some of the major factors that may have
been associated with that upturn. Finally, the study investigated whether some of the
factors behind the upturn in high HIV prevalence regions were different from those in
low HIV prevalence regions and if so, to establish structural relationships that explained
the mortality differences in the two HIV regions.
Data drawn from the 1993, 1998 and 2003 Kenya Demographic and Health Surveys
(KDHS) were used. A set of demographic data assessment and evaluation techniques
were used to address objective one. Parametric models (specifically the Weibull AFT
models) and regression decomposition techniques were used to address objectives two
and three respectively.
Preliminary findings showed that infant mortality increased by 30 percent while child
mortality increased by 9 percent during the 1988-2003 period. Data assessment revealed
that data were generally of high quality. In cases where there was heaping in age
reporting of children such as at months 12, the effect would only have lead to an
understatement of infant mortality and not its upsurge. Further, while there was heaping
at months 12, 18, 24 and 36, the effect of this bias on child mortality estimation is
negligible since all these ages are conventionally part of child mortality estimation.
Weibull AFT models revealed that compared to infants who were born during 1988-92
period, those born during the 1993-98 and 1999-2003 period were 43 percent more likely
to die faster respectively and this association was statistically significant (p value < 0.05).
During childhood, the risk of dying faster among children born during 1993-98 and 1999-
2003 was 45 percent and 28 percent as compared to those who were born during the
1988-92 period(p value < 0.05). Overall, the Weibull AFT models explained an upsurge
of 55 percent in infant mortality and 62 percent in child mortality(p value < 0.05).
The results obtained using regression decomposition techniques showed that there were
differences in the covariate values of mortality between the two periods and HIV regions.
Partially, these differences accounted for the differences in the observed infant and child
mortality by period and regional HIV prevalence. The differences in infant and child
mortality were largely due to the differences in the nature or structure of the relationship
between mortality components and the explanatory variables. Duration of breastfeeding,
maternal education, regional HIV prevalence and malaria endemicity appeared to explain
much of the observed change in infant mortality between the time periods. If all live
births that occurred in the 1996103 period had the same mean values of all explanatory
variables as those of 1988/95 period, then infant mortality would have increased by a
massive 14 deaths per 1000 live births. However, had live births that occurred in the
1988/95 period experienced the same mean values of all explanatory variables as those
that occurred in the 1996/03 period, the upsurge in infant mortality would have been
negligible.
The length of the preceding birth interval, belonging to a mother who received a tetanus
injection during pregnancy, maternal education, and malaria prevalence were important
explanatory variables behind the change in child mortality. The highest contribution to
child mortality during the 1988-2003 period was due to the rise in Malaria endemicity (18
percent increase) followed by the differences in regional HIV prevalence (5 percent
increase).
The difference in infant mortality between the high and low HIV zones was 9.2 deaths
per 1000 live births while that of child mortality was 2.3 deaths per 1000 live births. An
approximate 59 percent of the difference in infant mortality between the two HIV regions
was accounted for by the socio-economic factors alone. This exceeded the total
contribution of 56 percent increase in infant mortality that was observed between the two
HIV regions. Among the socio-economic factors, it appears that the source of drinking
water, type of toilet facility and household wealth index played a pivotal role in the
observed differences in infant mortality. On the other hand, the study variables explained
39 percent of the difference in child mortality between the two HIY regions. However, it
is maternal factors and socio-economic factors that contributed much to the child
mortality differences between the two HIV regions (20.4 and 13.8 percent respectively).
In summary, mortality increase was real during the 1988-2003 period. Efforts aimed at
controlling and preventing malaria and HIV should be stepped up to avert childhood
mortality. This could entail universal counselling and testing of HIV among pregnant
mothers and strengthening prevention of mother to child transmission initiatives;
intensified use of anti malaria prophylaxis among pregnant women and children as well
as early diagnosis and treatment of Malaria. Additionally, programs aimed at increasing
the distribution of Insecticide treated mosquito nets, in house spraying and other vector
control strategies in high Malaria prone regions as well as biomedical research for
malaria vaccine development need renewed emphasis. There is need to promote maternal
education given its known role in reducing infant and child mortality. There is need to
scale up family planning programmes to reduce short birth intervals and prevent high
risk births. An affordable social health insurance system should be introduced to cater
for low income households who cannot otherwise access any form of health care. Finally,
provision of clean and portable water needs to continue especially through water
purification techniques to households that do not have access to piped water. | en |
