Abstract

SummaryBackgroundProgress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015.MethodsWe did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 to 2015, using data from nationally representative Demographic Health Surveys done between 1989 and 2014. For comparison, we used modelled mortality estimates from the UN Inter-Agency Groups for Child and Maternal Mortality Estimation. We estimated time trends for key RMNCH indicators, as defined by Countdown to 2015, at both the national and the subnational level, and used linear regression methods to understand the determinants of change in intervention coverage during the past decade. Finally, we used the Lives Saved Tool (LiST) to model the effect of intervention scale-up by 2030.FindingsAfter an increase in mortality between 1990 and 2003, there was a reversal in all mortality trends from 2003 onwards, although progress was not substantial enough for Kenya to achieve Millennium Development Goal targets 4 or 5. Between 1990 and 2015, maternal mortality declined at half the rate of under-5 mortality, and changes in neonatal mortality were even slower. National-level trends in intervention coverage have improved, although some geographical inequities remain, especially for counties comprising the northeastern, eastern, and northern Rift Valley regions. Disaggregation of intervention coverage by wealth quintile also revealed wide inequities for several health-systems-based interventions, such as skilled birth assistance. Multivariable analyses of predictors of change in family planning, skilled birth assistance, and full vaccination suggested that maternal literacy and family size are important drivers of positive change in key interventions across the continuum of care. LiST analyses clearly showed the importance of quality of care around birth for maternal and newborn survival.InterpretationIntensified and focused efforts are needed for Kenya to achieve the RMNCH targets for 2030. Kenya must build on its previous progress to further reduce mortality through the widespread implementation of key preventive and curative interventions, especially those pertaining to labour, delivery, and the first day of life. Deliberate targeting of the poor, least educated, and rural women, through the scale-up of community-level interventions, is needed to improve equity and accelerate progress.FundingUS Fund for UNICEF, Bill & Melinda Gates Foundation.

Highlights

  • Since gaining independence in 1963, Kenya has become one of the most thriving nations in east Africa

  • This study aims to determine estimates and trends of maternal, neonatal, and under-5 mortality; assess coverage of key RMNCH interventions, disaggregated by standard equity variables; and examine the effect of specific interventions on mortality using the Lives Saved tool (LiST)

  • On the basis of data from the UN Maternal Mortality Estimation Inter-agency Group (MMEIG), maternal mortality declined from 687 deaths per 100 000 livebirths in 1990, to 510 per 100 000 in 2015, reflecting an overall average annual rate of reduction (ARR) of 1·2% and an absolute decline in mortality of 25·8%

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Summary

Introduction

Since gaining independence in 1963, Kenya has become one of the most thriving nations in east Africa. The innovation and technology sector is one of the most advanced in Africa, with escalations in mobile phone use and launch of the M-Pesa currency in 2007. Despite these successes, poverty levels remain high across the country, and health indicators in Kenya have not kept pace with other sectors. Increased rates of maternal and child mortality were noted in the earlyMDG period from 1990 to 1999,2,3 whereas neonatal mortality remained relatively unchanged This mixed and largely slow progress was partly compounded by underinvestment in health care, along with inequalities www.thelancet.com/lancetgh Vol 5 August 2017

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