Use of contraceptives, high risk births and under-five mortality in Sub Saharan Africa: evidence from Kenyan (2014) and Zimbabwean (2011) demographic health surveys

Admire Chikandiwa,Emma Burgess,Lucy Chimoyi,Kennedy Otwombe

doi:10.1186/s12905-018-0666-1

Admire Chikandiwa, Emma Burgess + Show 2 more

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https://doi.org/10.1186/s12905-018-0666-1

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Abstract

BackgroundIncreasing uptake of modern contraception is done to alleviate maternal and infant mortality in poor countries. We describe prevalence of contraceptive use, high risk births, under-five mortality and their risk factors in Kenya and Zimbabwe.MethodsThis was a cross-sectional analysis on DHS data from Kenya (2014) and Zimbabwe (2011) for women aged 15–49. Geospatial mapping was used to compare the proportions of the following outcomes: current use of contraceptives, high-risk births, and under-5 mortality at regional levels after applying sample weights to account for disproportionate sampling and non-responses. Multivariate risk factors for the outcomes were evaluated by multilevel logistic regression and reported as adjusted odds ratios (aOR).ResultsA total of 40,250 (31,079 Kenya vs. 9171 Zimbabwe) women were included in this analysis. Majority were aged 18–30 years (47%), married/cohabiting (61%) and unemployed (60%). Less than half were using contraceptives (36% Kenya vs. 41% Zimbabwe). Spatial maps, especially in the Kenyan North-eastern region, showed an inverse correlation in the current use of contraceptives with high risk births and under-5 mortality. At individual level, women that had experienced high risk births were likely to have attained secondary education in both Kenya (aOR = 5.20, 95% CI: 3.86–7.01) and Zimbabwe (aOR = 1.63, 95% CI: 1.08–2.25). In Kenya, high household wealth was associated with higher contraceptive use among both women who had high risk births (aOR: 1.72, 95% CI: 1.41–2.11) and under-5 mortality (aOR: 1.66, 95% CI: 1.27–2.16). Contraceptive use was protective against high risk births in Zimbabwe only (aOR: 0.79, 95% CI: 0.68–0.92) and under-five mortality in both Kenya (aOR: 0.79, 95% CI: 0.70–0.89) and Zimbabwe (aOR: 0.71, 95% CI: 0.61–0.83). Overall, community levels factors were not strong predictors of the three main outcomes.ConclusionsThere is a high unmet need of contraception services. Geospatial mapping might be useful to policy makers in identifying areas of greatest need. Increasing educational opportunities and economic empowerment for women could yield better health outcomes.

Highlights

Increasing uptake of modern contraception is done to alleviate maternal and infant mortality in poor countries
More effort will be required in developing regions and especially Sub-Saharan Africa [SSA] where maternal mortality ratio (MMR) remains way higher than in developed regions [2] and eight of ten deaths in children is under the age of five [3]
Descriptive analysis A total of 40,250 women were eligible for inclusion in this study; 31,079 from Kenya and 9171 from Zimbabwe

Summary

Introduction

Increasing uptake of modern contraception is done to alleviate maternal and infant mortality in poor countries. We describe prevalence of contraceptive use, high risk births, under-five mortality and their risk factors in Kenya and Zimbabwe. Increasing access to contraceptive methods has been recommended for the reduction of MMR and U-5MR [4]. The impact of contraceptive use on mortality is mediated through factors that include early births (mother’s age is below 18 years), giving birth late (mother’s age is above 34 years), short period of time between births (less than 2 years), and high parity rates In SSA, the contraceptive prevalence rates have remained low, and the region continues to face high MMR and U-5MR [8]. Available data from Kenya and Zimbabwe has suggested that child mortality rates are related to maternal factors which include age at childbirth, spacing of births and parity [10, 11]

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