Abstract
BackgroundDespite significant declines in under five mortality (U5M) over the last 3 decades, Kenya did not achieve Millennium Development Goal 4 (MDG 4) by 2015. To better understand trends and inequalities in child mortality, analysis of U5M variation at subnational decision making units is required. Here the comprehensive compilation and analysis of birth history data was used to understand spatio-temporal variation, inequalities and progress towards achieving the reductions targets of U5M between 1965 and 2013 and projected to 2015 at decentralized health planning units (counties) in Kenya.MethodsTen household surveys and three censuses with data on birth histories undertaken between 1989 and 2014 were assembled. The birth histories were allocated to the respective counties and demographic methods applied to estimate U5M per county by survey. To generate a single U5M estimate for year and county, a Bayesian spatio-temporal Gaussian process regression was fitted accounting for variation in sample size, surveys and demographic methods. Inequalities and the progress in meeting the goals set to reduce U5M were evaluated subnationally.ResultsNationally, U5M reduced by 61·6%, from 141·7 (121·6–164·0) in 1965 to 54·5 (44·6–65·5) in 2013. The declining U5M was uneven ranging between 19 and 80% across the counties with some years when rates increased. By 2000, 25 counties had achieved the World Summit for Children goals. However, as of 2015, no county had achieved MDG 4. There was a striking decline in the levels of inequality between counties over time, however, disparities persist. By 2013 there persists a 3·8 times difference between predicted U5M rates when comparing counties with the highest U5M rates against those with the lowest U5M rates.ConclusionKenya has made huge progress in child survival since independence. However, U5M remains high and heterogeneous with substantial differences between counties. Better use of the current resources through focused allocation is required to achieve further reductions, reduce inequalities and increase the likelihood of achieving Sustainable Development Goal 3·2 on U5M by 2030.
Highlights
Despite significant declines in under five mortality (U5M) over the last 3 decades, Kenya did not achieve Millennium Development Goal 4 (MDG 4) by 2015
The demographic methods and the spatio-temporal model allowed for 49 years of temporal predictions from 1965 to 2013 across all 47 counties
At the national level, there was a 61·6% reduction in the mean rate of U5M over 49 years from a rate of 141·7 deaths per 1000 live births in 1965 to 54·5 (44·6–65·5) per 1000 live births in 2013 (Fig. 2)
Summary
Despite significant declines in under five mortality (U5M) over the last 3 decades, Kenya did not achieve Millennium Development Goal 4 (MDG 4) by 2015. To better understand trends and inequalities in child mortality, analysis of U5M variation at subnational decision making units is required. The comprehensive compilation and analysis of birth history data was used to understand spatio-temporal variation, inequalities and progress towards achieving the reductions targets of U5M between 1965 and 2013 and projected to 2015 at decentralized health planning units (counties) in Kenya. Under-five mortality (U5M), the probability that a child will die before reaching the age of five, is a benchmark of a country’s health status and progress towards achievement of development goals [1, 2]. Disease burdens are expected to be concentrated in a few sub-national areas; identification of these areas and directing suitable interventions to these areas will accelerate national child mortality reductions and ensure effective and equitable resource allocation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
