The latest edition of Kenya Demographic and Health Survey (2022 KDHS) published by Kenya National Bureau of Statistics (KNBS) reveals that mortality rates for children are at the lowest level in the last three decades. Looking at that data, one may leave with the impression that trends of mortality rates for children below five years show tremendous progress. Yet this is only partly true.
The data shows that in 1993, the under-five mortality rate for Kenya was 96 per 1,000 live births. This has dropped by 57% to 41 deaths per 1,000 live births in 2022. On the other hand, neonatal mortality (the probability of death in the first month of life) is lower by 20% in the same period, from 26 to 21 per 1,000 live births as shown in the Chart 1 below.
However, at 41 deaths for under-five and 21 deaths for neonates, mortality rates for children in Kenya are still high compared to the world average in 2021 of 38 and 18 per 1,000 live births for under-five and neonates respectively. Kenya is a signatory of the United Nation’s Sustainable Development Goals (SDGs). Under Goal 3 of SDGs, the state members of the UN aim to reduce mortality rates for children under the age of five years (U5MR) to 21 and neonatal mortality rates (NMR) to 12 deaths per 1,000 live births respectively, by 2030. Regrettably, Kenya records double mortality rates of these targets.
Chart 1: Trends in Mortality Rates for Children of various Ages in Kenya (1993 to 2022
Three things are evident from the data presented in Chart 1 above. The first is that between 1993 to 2003, both neonatal and under-five mortality rates got worse, peaking in 2003. This could be attributed in part to high malaria prevalence at the time. Secondly, after 2003, mortality rates began to decline. However, the pace of reduction of the mortality rates for under-five (U5MR) was faster, indicated by a steeper slope compared to neonatal mortality (NMR), which is slower and nearly stagnant after 2014.
Thirdly, it is clear that lately, neonatal deaths contribute a large proportion of the under-five deaths. In 1993, 26 of the 96 deaths per 1,000 live births among children under five years were neonates, equivalent to 27%. In 2022, of the 41 deaths of children dying before attaining the age of five, 21 of them, which is 51%, die in the neonatal period. This suggests that the risk of mortality among children is now higher in the first month of life and that more progress has been made in preserving the lives of children after the neonatal period.
Interventions in Place
Some of the interventions for reducing mortality among children are antenatal care for pregnant women, delivery of babies in health facilities and vaccination for the new-borns. Let us consider each briefly.
Vaccination is considered among the most cost-effective interventions to prevent diseases, especially among children. In Kenya, the Expanded Programme on Immunization guides vaccination in the country. The KDHS 2022 shows that the coverage of childhood vaccination, also called immunization, for basic antigens in 2022 is at 80%. This is stagnation considering that in 1993, immunization coverage was at 79%. In 2003, immunization coverage was at 57%, the same time child mortality was highest as shown in Chart 2 below.
Chart 2: Showing the status of interventions between 1993 and 2022
A different measure of immunization coverage focuses on children between 12-23 months and 24-35 months who are fully vaccinated according to the national schedule. Between 12-23 months, the survey established that only 55% of children were fully vaccinated. For ages 24-35 months, the coverage was as low as 38% for the whole country. This means that after the age of one year, vaccinations rates drop significantly, which exposes children to fatal but preventable illnesses.
Back to the crucial issue of vaccination for basic antigens. The 20% of children left out of the vaccination programme today is much bigger compared to 21% in 1993, owing to population change in the intervening three decades. According to KNBS (various Statistical Abstracts), registered births in 1993 was 290,000. This has increased fourfold to 1.2 million in 2021. Therefore, leaving out 20% of children from basic vaccination is the same as not vaccinating all children born in 1993. This is a grave situation as it places a high number of children at risk of avoidable illness and early death.
In essence, there has been no progress in the immunisation rates in the last 30 years and this has negative consequences on the pace at which both neonatal and U5MR is reduced. Even further, immunisation coverage varies across different regions in the country. For example, the vaccination coverage for children in Nyandarua County in 2022 was 95% while the rates for Garissa and Mandera counties were at 23% and 29% respectively. The high coverage in Nyandarua County could be due to the fact it is small and densely populated compared to the latter which are large areas with lower population densities.
It is also worth noting that Garissa and Mandera counties, with the lowest immunization coverage rates in Kenya, continue to record very high mortality rates among children. This suggests that the government of Kenya policy and programme for immunisation is not adequately targeted to provide coverage for these most deprived areas. Remember also that these counties border states with dysfunctional governments which cannot effectively administer vaccination to their populations and migration and population movements raise the risks of infections for children.
Another effective intervention is the quest to ensure delivery of babies in registered healthcare facilities. In 1993, only 42% of mothers delivered babies in healthcare facilities. This has significantly improved and to reach 82% in 2022 (see 2022 KDHS). It is reasonable to state that healthcare facilities offer proper medical attention under hygienic conditions during delivery and thus help to reduce the risk of fatal complications and infections for both mother and baby.
The Linda Mama Programme, a free maternity programme introduced in 2013 and which covers pregnant women who are not under any other medical insurance scheme, during their delivery in public health facilities to encourage more safe deliveries is therefore an appropriate policy intervention. It is until the evaluation of the programme is done when we can measure its success.
The last intervention that we shall consider here, and which is as crucial, is antenatal care. The World Health Organization defines antenatal care (ANC) as care provided by skilled healthcare professionals to pregnant women in order to ensure the best health conditions for both mother and the unborn baby. ANC includes risk identification, prevention and management of pregnancy-related diseases as well as health education.
Consequently, effective antenatal care leads to reduced sicknesses and deaths that occur around birth: directly through the early detection and treatment of pregnancy-related complications and indirectly through the timely identification of risky pregnancies for appropriate and timely referrals. In that case, one would expect ANC to be prevalent. Unfortunately, it is not the case.
In Chapter Three of the KDHS 2022 (also in Chart 2 above), we see that only two thirds (66%) of expectant mothers attended four or more ANC clinics as recommended by the WHO. Still, most pregnant women begin ANC clinics as late as the final trimester of their pregnancy. The Kenya Malaria Indicator Survey of 2020 shows that only 28% of pregnant women start ANC clinics during the first trimester. As such, many expectant mothers expose themselves and unborn babies to avoidable health risks and complications.
The KDHS surveys also reveal that the quality of antenatal care is inconsistent in that not all women receive important information on possible pregnancy complications. Consequently, it is possible to conclude that at times, there lacks proper medical attention leading to missing crucial details, which end up being costly to mothers and new-borns.
Nevertheless, desirable health outcomes of antenatal care can still achievable by addressing both supply side and demand side aspects. On the demand side, quality antenatal care, which depends on well-equipped and sufficiently staffed health facilities should be guaranteed. The upgrading of healthcare facilities as envisioned in the Kenya Health Policy 2014-2030 should be a priority development item for the government(s) in Kenya in order to improve the quality of antenatal care and healthcare services in general.
In addition, as argued by Van Lerberghe and Browuwere (2001) in “Safe Motherhood Strategies: A Review of the Evidence”, skilled antenatal care providers must maintain higher standards of professionalism in the provision of pregnancy care. There is a need for a standardized checklist of tests and procedures during antenatal care. This will ensure thorough examinations are carried out making it possible for detection of potential risks and complications early enough, allowing for timely deployment of appropriate measures that will help save lives.
On the supply side, as other studies have shown, that among other things, there exists a strong correlation between the level of education of the mother and ANC utilization. Therefore, it is necessary for continued emphasis on public policies that raise the transition from primary to secondary school, ensuring completion of basic education, especially for girls. A simple calculation from data on transition rates for 2022 (See Chapter 15 of 2023 Economic Survey) reveal that only 473,300 girls of 603,647, that is 78%, who sat for KCPE in 2021 joined secondary schools. This high rate of dropout means that more girls miss out on the important basic education which consequently negatively affects how they make healthcare decisions that affect themselves and their babies.
Conclusion
Preventable childhood deaths are unacceptable. There is an urgent need for adequate and targeted interventions. The national government, through the Ministry of Public Health and Sanitation must quickly invest in relevant public health programs and help to raise immunisations rates, with particular focus on counties that are most deprived. Failure by the national government to boost rates of vaccination (which is more cost-effective for prevention of morbidity and mortality) complicates the work of county governments because they have to provide treatment for illnesses that result from inadequate vaccination. Treatment is more expensive and where it cannot be accessed on time, ultimate price in the form of loss of lives, is incurred. It is important that the Linda Mama programme is implemented properly so as to raise the rates of delivery in healthcare facilities, especially for the low-income populations. Safe deliveries reduce health risks leading to better health outcomes for both mother and child. Finally, promoting policies that lead to high literacy levels of women and girls will lead to improved maternal and child health, and consequently reduced mortalities. This is because educated mothers are more likely to make better childcare decisions.
1. Introduction Fiscal decentralisation is a core part of Kenya’s Constitutional order. Fiscal decentralisation is allocating revenue and expenditure responsibilities to lower levels of government. Kenya’s identity as a sovereign republic, as stated in Article 4 of its Constitution, is deeply intertwined with the national value of devolution, emphasised in Article 10. This unique relationship […]
Introduction The Constitutional Theory of Public Goods argues that people decide which goods are public goods at a constitutional level. This decision is based on how much their enjoyment of the good depends on others also enjoying it (Marmolo 1999).i The theory suggests that the government should provide public goods where there is significant demand […]
The National Treasury has published the latest national edition of Program-Based Budget estimates for 2024/25. My reading of the document suggests that the documents reflect a strategic investment in socio-economic advancement, highlighting the Kenyan government’s dedication to addressing the challenges women face and steadfastly promoting gender equality with determination. A quick search within this budget […]
The Houthi’s are Yemeni political actors. The Houthis, and Somali pirates have been launching direct kinetic attacks on shipping assets. The Houthi’s are understood to be allies if not proxies of Iran. They use Iranian weapons and take some level of political direction from Iran. The Houthi’s explain that their attacks are designed to offer […]
Introduction Conditional on the passage of the Finance Bill 2024, a 750 ml bottle of 37% alcohol by volume of a popular beverage gin in Kenya will now have an excise tax of Ksh 444, up from Ksh 267. On the other hand, a 500ml Tusker Cider that used to have a tax burden of […]
Post date: Wed, Aug 16, 2023 |
Category: Health |
By: Jairus Kedogo, |
The latest edition of Kenya Demographic and Health Survey (2022 KDHS) published by Kenya National Bureau of Statistics (KNBS) reveals that mortality rates for children are at the lowest level in the last three decades. Looking at that data, one may leave with the impression that trends of mortality rates for children below five years show tremendous progress. Yet this is only partly true.
The data shows that in 1993, the under-five mortality rate for Kenya was 96 per 1,000 live births. This has dropped by 57% to 41 deaths per 1,000 live births in 2022. On the other hand, neonatal mortality (the probability of death in the first month of life) is lower by 20% in the same period, from 26 to 21 per 1,000 live births as shown in the Chart 1 below.
However, at 41 deaths for under-five and 21 deaths for neonates, mortality rates for children in Kenya are still high compared to the world average in 2021 of 38 and 18 per 1,000 live births for under-five and neonates respectively. Kenya is a signatory of the United Nation’s Sustainable Development Goals (SDGs). Under Goal 3 of SDGs, the state members of the UN aim to reduce mortality rates for children under the age of five years (U5MR) to 21 and neonatal mortality rates (NMR) to 12 deaths per 1,000 live births respectively, by 2030. Regrettably, Kenya records double mortality rates of these targets.
Chart 1: Trends in Mortality Rates for Children of various Ages in Kenya (1993 to 2022
Three things are evident from the data presented in Chart 1 above. The first is that between 1993 to 2003, both neonatal and under-five mortality rates got worse, peaking in 2003. This could be attributed in part to high malaria prevalence at the time. Secondly, after 2003, mortality rates began to decline. However, the pace of reduction of the mortality rates for under-five (U5MR) was faster, indicated by a steeper slope compared to neonatal mortality (NMR), which is slower and nearly stagnant after 2014.
Thirdly, it is clear that lately, neonatal deaths contribute a large proportion of the under-five deaths. In 1993, 26 of the 96 deaths per 1,000 live births among children under five years were neonates, equivalent to 27%. In 2022, of the 41 deaths of children dying before attaining the age of five, 21 of them, which is 51%, die in the neonatal period. This suggests that the risk of mortality among children is now higher in the first month of life and that more progress has been made in preserving the lives of children after the neonatal period.
Interventions in Place
Some of the interventions for reducing mortality among children are antenatal care for pregnant women, delivery of babies in health facilities and vaccination for the new-borns. Let us consider each briefly.
Vaccination is considered among the most cost-effective interventions to prevent diseases, especially among children. In Kenya, the Expanded Programme on Immunization guides vaccination in the country. The KDHS 2022 shows that the coverage of childhood vaccination, also called immunization, for basic antigens in 2022 is at 80%. This is stagnation considering that in 1993, immunization coverage was at 79%. In 2003, immunization coverage was at 57%, the same time child mortality was highest as shown in Chart 2 below.
Chart 2: Showing the status of interventions between 1993 and 2022
A different measure of immunization coverage focuses on children between 12-23 months and 24-35 months who are fully vaccinated according to the national schedule. Between 12-23 months, the survey established that only 55% of children were fully vaccinated. For ages 24-35 months, the coverage was as low as 38% for the whole country. This means that after the age of one year, vaccinations rates drop significantly, which exposes children to fatal but preventable illnesses.
Back to the crucial issue of vaccination for basic antigens. The 20% of children left out of the vaccination programme today is much bigger compared to 21% in 1993, owing to population change in the intervening three decades. According to KNBS (various Statistical Abstracts), registered births in 1993 was 290,000. This has increased fourfold to 1.2 million in 2021. Therefore, leaving out 20% of children from basic vaccination is the same as not vaccinating all children born in 1993. This is a grave situation as it places a high number of children at risk of avoidable illness and early death.
In essence, there has been no progress in the immunisation rates in the last 30 years and this has negative consequences on the pace at which both neonatal and U5MR is reduced. Even further, immunisation coverage varies across different regions in the country. For example, the vaccination coverage for children in Nyandarua County in 2022 was 95% while the rates for Garissa and Mandera counties were at 23% and 29% respectively. The high coverage in Nyandarua County could be due to the fact it is small and densely populated compared to the latter which are large areas with lower population densities.
It is also worth noting that Garissa and Mandera counties, with the lowest immunization coverage rates in Kenya, continue to record very high mortality rates among children. This suggests that the government of Kenya policy and programme for immunisation is not adequately targeted to provide coverage for these most deprived areas. Remember also that these counties border states with dysfunctional governments which cannot effectively administer vaccination to their populations and migration and population movements raise the risks of infections for children.
Another effective intervention is the quest to ensure delivery of babies in registered healthcare facilities. In 1993, only 42% of mothers delivered babies in healthcare facilities. This has significantly improved and to reach 82% in 2022 (see 2022 KDHS). It is reasonable to state that healthcare facilities offer proper medical attention under hygienic conditions during delivery and thus help to reduce the risk of fatal complications and infections for both mother and baby.
The Linda Mama Programme, a free maternity programme introduced in 2013 and which covers pregnant women who are not under any other medical insurance scheme, during their delivery in public health facilities to encourage more safe deliveries is therefore an appropriate policy intervention. It is until the evaluation of the programme is done when we can measure its success.
The last intervention that we shall consider here, and which is as crucial, is antenatal care. The World Health Organization defines antenatal care (ANC) as care provided by skilled healthcare professionals to pregnant women in order to ensure the best health conditions for both mother and the unborn baby. ANC includes risk identification, prevention and management of pregnancy-related diseases as well as health education.
Consequently, effective antenatal care leads to reduced sicknesses and deaths that occur around birth: directly through the early detection and treatment of pregnancy-related complications and indirectly through the timely identification of risky pregnancies for appropriate and timely referrals. In that case, one would expect ANC to be prevalent. Unfortunately, it is not the case.
In Chapter Three of the KDHS 2022 (also in Chart 2 above), we see that only two thirds (66%) of expectant mothers attended four or more ANC clinics as recommended by the WHO. Still, most pregnant women begin ANC clinics as late as the final trimester of their pregnancy. The Kenya Malaria Indicator Survey of 2020 shows that only 28% of pregnant women start ANC clinics during the first trimester. As such, many expectant mothers expose themselves and unborn babies to avoidable health risks and complications.
The KDHS surveys also reveal that the quality of antenatal care is inconsistent in that not all women receive important information on possible pregnancy complications. Consequently, it is possible to conclude that at times, there lacks proper medical attention leading to missing crucial details, which end up being costly to mothers and new-borns.
Nevertheless, desirable health outcomes of antenatal care can still achievable by addressing both supply side and demand side aspects. On the demand side, quality antenatal care, which depends on well-equipped and sufficiently staffed health facilities should be guaranteed. The upgrading of healthcare facilities as envisioned in the Kenya Health Policy 2014-2030 should be a priority development item for the government(s) in Kenya in order to improve the quality of antenatal care and healthcare services in general.
In addition, as argued by Van Lerberghe and Browuwere (2001) in “Safe Motherhood Strategies: A Review of the Evidence”, skilled antenatal care providers must maintain higher standards of professionalism in the provision of pregnancy care. There is a need for a standardized checklist of tests and procedures during antenatal care. This will ensure thorough examinations are carried out making it possible for detection of potential risks and complications early enough, allowing for timely deployment of appropriate measures that will help save lives.
On the supply side, as other studies have shown, that among other things, there exists a strong correlation between the level of education of the mother and ANC utilization. Therefore, it is necessary for continued emphasis on public policies that raise the transition from primary to secondary school, ensuring completion of basic education, especially for girls. A simple calculation from data on transition rates for 2022 (See Chapter 15 of 2023 Economic Survey) reveal that only 473,300 girls of 603,647, that is 78%, who sat for KCPE in 2021 joined secondary schools. This high rate of dropout means that more girls miss out on the important basic education which consequently negatively affects how they make healthcare decisions that affect themselves and their babies.
Conclusion
Preventable childhood deaths are unacceptable. There is an urgent need for adequate and targeted interventions. The national government, through the Ministry of Public Health and Sanitation must quickly invest in relevant public health programs and help to raise immunisations rates, with particular focus on counties that are most deprived. Failure by the national government to boost rates of vaccination (which is more cost-effective for prevention of morbidity and mortality) complicates the work of county governments because they have to provide treatment for illnesses that result from inadequate vaccination. Treatment is more expensive and where it cannot be accessed on time, ultimate price in the form of loss of lives, is incurred. It is important that the Linda Mama programme is implemented properly so as to raise the rates of delivery in healthcare facilities, especially for the low-income populations. Safe deliveries reduce health risks leading to better health outcomes for both mother and child. Finally, promoting policies that lead to high literacy levels of women and girls will lead to improved maternal and child health, and consequently reduced mortalities. This is because educated mothers are more likely to make better childcare decisions.
1. Introduction Fiscal decentralisation is a core part of Kenya’s Constitutional order. Fiscal decentralisation is allocating revenue and expenditure responsibilities to lower levels of government. Kenya’s identity as a sovereign republic, as stated in Article 4 of its Constitution, is deeply intertwined with the national value of devolution, emphasised in Article 10. This unique relationship […]
Introduction The Constitutional Theory of Public Goods argues that people decide which goods are public goods at a constitutional level. This decision is based on how much their enjoyment of the good depends on others also enjoying it (Marmolo 1999).i The theory suggests that the government should provide public goods where there is significant demand […]
The National Treasury has published the latest national edition of Program-Based Budget estimates for 2024/25. My reading of the document suggests that the documents reflect a strategic investment in socio-economic advancement, highlighting the Kenyan government’s dedication to addressing the challenges women face and steadfastly promoting gender equality with determination. A quick search within this budget […]
The Houthi’s are Yemeni political actors. The Houthis, and Somali pirates have been launching direct kinetic attacks on shipping assets. The Houthi’s are understood to be allies if not proxies of Iran. They use Iranian weapons and take some level of political direction from Iran. The Houthi’s explain that their attacks are designed to offer […]
Introduction Conditional on the passage of the Finance Bill 2024, a 750 ml bottle of 37% alcohol by volume of a popular beverage gin in Kenya will now have an excise tax of Ksh 444, up from Ksh 267. On the other hand, a 500ml Tusker Cider that used to have a tax burden of […]