Mortality In Kenya Research Articles

Catastrophic Health Expenditure and Household Impoverishment: a case of NCDs prevalence in Kenya


 ntroduction and problem: Non-Communicable Diseases (NCDs) have become one of the leading causes of morbidity and mortality in Kenya. Their claim on financial and time resources adversely affects household welfare. Health care cost for NCDs in Kenya is predominantly paid by households as OOP. Health expenditure on NCD stands at 6.2% of Total Health Expenditure which is 0.4 % of the total gross domestic product of the country. This expenditure scenario could have implications on household welfare through catastrophic expenditure in Kenya. Most studies done on catastrophic expenditure in Kenya have not looked at the effect of NCD on poverty. Methodology: The paper has investigated the determinants of catastrophic health spending in a household with special focus on the NCDs. It has also investigated the effect of catastrophic expenditure on household welfare.A National household level survey data on expenditure and utilization is used. Controlling for endogeneity, the results revealed that NCDs and communicable diseases contribute significantly to the likelihood of a household incurring catastrophic expenditure. Results: Although all types of sicknesses have negative effects on household welfare, NCDs have more severe impacts on impoverishment. Policy wise, government and development partners should put in place a health financing plan entailing health insurance and resource pooling as a mean towards social protection.
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Term Newborn Care Recommendations Provided in a Kenyan Postnatal Ward: A Rapid, Focused Ethnographic Assessment.

Neonatal mortality (death within 0-28 d of life) in Kenya is high despite strong evidence that newborn care recommendations save lives. In public healthcare facilities, nurses counsel caregivers on term newborn care, but knowledge about the content and quality of nurses' recommendations is limited. To describe the term newborn care recommendations provided at a tertiary-level, public referral hospital in Western Kenya, how they were provided, and related content taught at a university nursing school. A rapid, focused ethnographic assessment, guided by the culture care theory, using stratified purposive sampling yielded 240 hours of participant observation, 24 interviews, 34 relevant documents, and 268 pages of field notes. Data were organized using NVivo software and key findings identified using applied thematic analysis. Themes reflect recommendations for exclusive breastfeeding, warmth, cord care, follow-up examinations, and immunizations, which were provided orally in Kiswahili and some on a written English discharge summary. Select danger sign recommendations were also provided orally, if needed. Some recommendations conflicted with other providers' guidance. More recommendations for maternal care were provided than for newborn care. There is need for improved consistency in content and provision of recommendations before discharge. Findings should be used to inform teaching, clinical, and administrative processes to address practice competency and improve nursing care quality. Larger studies are needed to determine whether evidence-based recommendations are provided consistently across facilities and other populations, such as community-born and premature newborns, who also experience high rates of neonatal mortality in Kenya.

Determinants of Breast Cancer Screening among Rural Women, Homa Bay County, and Western Kenya

Breast cancer is a serious disease and it is one of the major causes of morbidity and mortality in Kenya and the World as a whole. It can be controlled by early detection, and prompt treatment or management. This paper aimed to demonstrate the screening levels of breast cancer among women in Homa-Bay County and determine factors associated with breast cancer screening. This was a cross-sectional study, which was done in April 2019 in two purposively selected sub-counties in Homa Bay County, Western Kenya. A region, which had previously registered lower screening levels of cancer in national surveys. Data analysis was majorly descriptive showing proportions. A Chi-square test was used to check for the association of categorical variables with breast cancer screening. Results indicated that the majority of the respondents had not gone (87.35%) for screening compared to those who had gone for screening (12.65%). Factors that were found to be significantly associated with breast cancer included if the woman was smoking (Chi-Square p-value = 0.02, history of a family member diagnosed with breast cancer (Chi-Square p-value = 0.004), and having undergone X-ray at one point in life (Chi-Square p-value = 0.021). The study concluded that breast cancer screening is still very low in Homa- Bay County and factors such as smoking and having a family member who had been diagnosed with breast cancer are associated with breast cancer screening. We recommend an increased health promotion and education activities based on breast cancer screening so that the women can go for the available cost-effective screening methods such as Clinical Breast Examination in Homa Bay County. This can be done through increased campaigns for breast cancer screening and home visits to encourage breast cancer screening or self-breast examination.

A Spatial Survival Model for Risk Factors of Under-Five Child Mortality in Kenya.

Child mortality is high in Sub-Saharan Africa compared to other regions in the world. In Kenya, the risk of mortality is assumed to vary from county to county due to diversity in socio-economic and even climatic factors. Recently, the country was split into 47 different administrative regions called counties, and health care was delegated to those county governments, further aggravating the spatial differences in health care from county to county. The goal of this study is to evaluate the effects of spatial variation in under-five mortality in Kenya. Data from the Kenya Demographic Health Survey (KDHS-2014) consisting the newly introduced counties was used to analyze this risk. Using a spatial Cox Proportional Hazard model, an Intrinsic Conditional Autoregressive Model (ICAR) was fitted to account for the spatial variation among the counties in the country while the Cox model was used to model the risk factors associated with the time to death of a child. Inference regarding the risk factors and the spatial variation was made in a Bayesian setup based on the Markov Chain Monte Carlo (MCMC) technique to provide posterior estimates. The paper indicate the spatial disparities that exist in the country regarding child mortality in Kenya. The specific counties have mortality rates that are county-specific, although neighboring counties have similar hazards for death of a child. Counties in the central Kenya region were shown to have the highest hazard of death, while those from the western region had the lowest hazard of death. Demographic factors such as the sex of the child and sex of the household head, as well as social economic factors, such as the level of education, accounted for the most variation when spatial differences were factored in. The spatial Cox proportional hazard frailty model performed better compared to the non-spatial non-frailty model. These findings can help the country to plan health care interventions at a subnational level and guide social and health policies by ensuring that counties with a higher risk of Under Five Child Mortality (U5CM) are considered differently from counties experiencing a lower risk of death.

Assessing individual factors associated with choice of place of delivery among postnatal women in Marsabit County, Kenya.

Background: Globally, about 295,000 maternal deaths occurred in 2017 with Sub-Saharan Africa and Asia accounting for 86%. Sub-Saharan Africa alone accounted for nearly two-thirds. The rate of skilled birth attendant in Sub-African region stood at 59%. Three quarters of neonatal and maternal deaths occur outside hospital settings. Currently, the rate of maternal mortality in Kenya stands at 362 per 100,000 live births. Despite the deliberate government interventions to increase hospital deliveries, still a significant number of women deliver at home. The objective of this study was to assess the individual actors associated with choice of place of delivery among postnatal women in Marsabit County, Kenya. Methods: This was a cross-sectional descriptive study adopting both quantitative and qualitative data collection methods. A total of 416 postnatal women were systematically sampled from households at a predetermined interval of four. Key informants interviews and focused group discussions provided additional qualitative data.Results: Approximately 56.7% of postnatal women in Marsabit County delivered in health facilities. Most individual factors such as decision maker (p=0.031), myths and misconceptions (p=0.025), reduction of complications (p=0.001), hospital delivery time consuming (p=0.023) and possession of medical insurance (p=0.001) were significantly associated with choice of place of delivery. Conclusions: Approximately 6 out 10 deliveries occur at health facilities in Marsabit County. Individual factors significantly influenced choice of place of delivery. There is need for the ministry of health, County Government of Marsabit and relevant stakeholders to demystify myths and misconceptions about hospital deliveries, scale up awareness on availability of Linda Mama medical cover for pregnant women to ensure easy access of hospital delivery services.

Cost and consequences of using 7.1\u2009% chlorhexidine gel for newborn umbilical cord care in Kenya

BackgroundOmphalitis is an important contributor to neonatal mortality in Kenya. Chlorhexidine digluconate 7.1 % w/w (CHX; equivalent to 4 % w/w chlorhexidine) was identified as a life-saving commodity for newborn cord care by the United Nations and is included on World Health Organization and Kenyan Essential Medicines Lists. This pilot study assessed the potential resource savings and breakeven price of implementing CHX for neonatal umbilical cord care versus dry cord care (DCC) in Kenya.MethodsWe employed a cost-consequence model in a Kenyan birth cohort. Firstly, the number of omphalitis cases and cases avoided by healthcare sector were estimated. Incidence rates and treatment effect inputs were calculated from a Cochrane meta-analysis of randomised clinical trials (RCTs) (base case) and 2 other RCTs. Economic outcomes associated with omphalitis cases avoided were determined, including direct, indirect and total cost of care associated with omphalitis, resource use (outpatient visits and bed days) and societal impact (caregiver workdays lost). Costs and other inputs were sourced from literature and supplemented by expert clinical opinion/informed inputs, making necessary assumptions.ResultsThe model estimated that, over 1 year, ~ 23,000 omphalitis cases per 500,000 births could be avoided through CHX application versus DCC, circumventing ~ 13,000 outpatient visits, ~ 43,000 bed days and preserving ~ 114,000 workdays. CHX was associated with annual direct cost savings of ~ 590,000 US dollars (USD) versus DCC (not including drug-acquisition cost), increasing to ~ 2.5 million USD after including indirect costs (productivity, notional salary loss). The most-influential model parameter was relative risk of omphalitis with CHX versus DCC. Breakeven analysis identified a budget-neutral price for CHX use of 1.18 USD/course when accounting for direct cost savings only, and 5.43 USD/course when including indirect cost savings. The estimated breakeven price was robust to parameter input changes. DCC does not necessarily represent standard of care in Kenya; other, potentially harmful, approaches may be used, meaning cost savings may be understated.ConclusionsEstimated healthcare cost savings and potential health benefits provide compelling evidence to implement CHX for umbilical cord care in Kenya. We encourage comprehensive data collection to make future models and estimates of impacts of upscaling CHX use more robust.

Women's rights agenda and fragmented advocacy for safe abortion in Kenya

ABSTRACT Restrictive abortion laws resulting in unsafe abortions form one of the key causes of maternal morbidity and mortality in Kenya. Despite the existence of several Women's Rights Organisations (WROs), advocacy for safe abortions against restrictive laws does not have the momentum the subject deserves. This research draws on agenda-setting literature to explore factors that impede advocacy initiatives of WROs against restrictive abortion laws in Kenya. Using qualitative methods, the article shows that women's rights agenda results from existing societal norms, funding priorities, state legislation, and lack of solidarity among WROs.

Causes of preterm and low birth weight neonatal mortality in a rural community in Kenya: evidence from verbal and social autopsy

BackgroundUnder-five mortality in Kenya has declined over the past two decades. However, the reduction in the neonatal mortality rate has remained stagnant. In a country with weak civil registration and vital statistics systems, there is an evident gap in documentation of mortality and its causes among low birth weight (LBW) and preterm neonates. We aimed to establish causes of neonatal LBW and preterm mortality in Migori County, among participants of the PTBI-K (Preterm Birth Initiative-Kenya) study.MethodsVerbal and social autopsy (VASA) interviews were conducted with caregivers of deceased LBW and preterm neonates delivered within selected 17 health facilities in Migori County, Kenya. The probable cause of death was assigned using the WHO International Classification of Diseases (ICD-10).ResultsBetween January 2017 to December 2018, 3175 babies were born preterm or LBW, and164 (5.1%) died in the first 28 days of life. VASA was conducted among 88 (53.7%) of the neonatal deaths. Almost half (38, 43.2%) of the deaths occurred within the first 24 h of life. Birth asphyxia (45.5%), neonatal sepsis (26.1%), respiratory distress syndrome (12.5%) and hypothermia (11.0%) were the leading causes of death. In the early neonatal period, majority (54.3%) of the neonates succumbed to asphyxia while in the late neonatal period majority (66.7%) succumbed to sepsis. Delay in seeking medical care was reported for 4 (5.8%) of the neonatal deaths.ConclusionDeaths among LBW and preterm neonates occur early in life due to preventable causes. This calls for enhanced implementation of existing facility-based intrapartum and immediate postpartum care interventions, targeting asphyxia, sepsis, respiratory distress syndrome and hypothermia.

Modeling Infant Mortality Risk Factors using Logistic Regression Model and Spatial Analysis in Kenya

Globally, infant mortality is used as an important indicator for healthcare status hence an important tool for evaluation and planning of public health strategies. Despite of numerous interventions by governments aimed at reducing infant mortality, high rates are still reported in Kenya. A lot of resources are channeled towards its control leading to low productivity hence impacting the household economic welfare and national GD. The specific objective was to establish risk factors and the spatial variation of infant mortality in Kenya by analyzing the 2014 Kenya Demographic Health Survey data. A fully Bayesian paradigm and logistic regression model were used to determine infant mortality risk factors and spatial variation in Kenya. Demographic, socioeconomic and environmental factors were found to have significant effect on infant mortality. Counties from the northern parts of Kenya, Rift Valley, Central, Eastern, Nyanza, Coastal and Western parts of Kenya showed a high level of infant deaths. Infant mortality is high in arid and semi-arid areas and coastal areas due to high prevalence of infectious diseases and inadequate water supply, health facilities and low education levels. Infant mortality varies significantly across regions in Kenya due to cultural activities, and weather patterns hence exists spatial autocorrelation among neighboring regions.

Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014

BackgroundTo improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning...

Determinants of Neonatal Mortality in Kenya: Evidence from the Kenya Demographic and Health Survey 2014.

Background:Globally, there has been a marked decline in neonatal mortality and overall child mortality indicators from 1990 to date. In Kenya, neonatal deaths remain unacceptably high, contributing to 40% of under-five mortality rates (U5MR) making it an important health priority. The objective of this study was to identify the determinants of neonatal mortality in Kenya. An understanding of the determinants of neonatal mortality will provide evidence for better interventions to reduce these deaths.Methods:Neonatal deaths from singleton live-born infants were extracted from women’s dataset collected for the 5-year period preceding the study published in the Kenya Demographic and Health Survey (KDHS), 2014. Data were obtained from 18,951 births. There were 356 neonatal deaths recorded. Data were weighted using an individual weighting factor to adjust for the study design and reduce sample variability. Data were analyzed using SPSS version 20.0. Logistic regression was conducted to adjust for confounding factors.Results:Neonatal mortality rate was established at 19/1000 (95% CI: 16.8-20.7). Mothers with no education had higher odds of experiencing deaths of neonates with adjusted Odds Ratio (aOR)=2.201, 95% CI: 1.43-4.15,p=0.049) compared to mothers with higher education. Low Birth Weight (LBW) neonates were 3.2 times likely to die in the first 28 days (aOR=3.206, 95% CI: 1.85-12.08, p=0.006) compared to neonates with >3.5 kilograms at birth. Mothers who did not attend ANC during pregnancy and those who attended between 1-3 ANC visits had higher odds of losing their infants (aOR=3.348, 95% CI: 1.616-8.53, p=0.041, and aOR=2.316, 95% CI: 1.10-4.88, p=0.027) respectively, compared to mothers who attended >4 ANC visits.Conclusion and Global Health Implications:Improving maternal health and nutrition during pregnancy should be enhanced to ensure adequate weight gain and reduce instances of low birth weight. Community referrals and follow-up for expectant women to take up the requisite 4 ANC visits should be encouraged. Girls’ education should be emphasized to reduce the proportion of illiterate mothers.

Survival Analysis of Child Mortality in Kenya: An Analysis of 2014 Kenya Demographic and Health Survey Data

Childhood mortality is still a public health issue in Sub-Saharan Africa, with Kenya being among the countries that experience the highest rate of children dying before reaching the age of five. Under-5 child mortality (U5CM) is heavily influenced by demographic, environmental, and socio-economic factors. The study aimed to examine the risk factors of under-5 child mortality in Kenya. The data were based on birth histories from the Kenya Demographic and Health Surveys (KDHS) conducted in 2014. The relative contribution of factors such as the mother's education, mother's occupation, household wealth, place of residence, region, and sex of the child to the variability in the under-five child mortality was assessed using Kaplan-Meier and Cox hazard methods. The outcome variable for the study was the child’s survival before the age of 5 and age at death. All children born in the period between 2009 and 2014 (n=83,591) were included in the study. Within the observation period, a total of 6,123 child deaths were recorded. The under-5 mortality rate in Kenya was strongly associated with the mother's education, region, place of residence, preceding birth interval, birth order, the total number of children ever born, mother's occupation, and type of toilet facility. The results indicated that a child born in Nyanza is twice more likely to die than that born in the Central region of Kenya. Male children had a higher risk of dying before the age of five than their female counterparts. The risk of experiencing U5CM increased among children born in rural areas compared to those born in urban areas. The study findings provide evidence in support of prioritizing interventions aiming at improving maternal and child healthcare. The findings also suggest that programs aimed at empowering women and boosting health knowledge among mothers should be scaled up. Furthermore, implementing socio-economic development interventions that reduce regional disparities is a recommendation that the central government should consider. Finally, national and local governments should commit resources to guarantee that modern contraceptives are available and used to increase child spacing.

Multilevel modelling of factors affecting child mortality in Kenya

Multilevel modelling of factors affecting child mortality in Kenya

Management of diabetes mellitus at the household level using community health strategy in Embu County, Kenya

Introductiondiabetes mellitus (DM) causes 1% of the mortality in Kenya and 2% of the population in Kenya has diabetes mellitus. Embu County was the 5th leading county in diabetes mellitus morbidity in Kenya in 2019. This study aimed at assessing the management of diabetes mellitus at the household level using the community health strategy in Embu County. Community health strategies in the county is implemented using Community Health Volunteers.Methodsit was a cross-sectional study using 422 household participants in Embu County and 150 community health volunteers´ (CHVs). Key informant interviews were used on community health strategy managers involved in diabetes management programmes in the County. Data was analyzed using SPSS version 25.Resultsfactors that were positively associated with effective management of DM at household level in the County were financial support and supervision of community health units, provision of tools and commodities, use of health information system, training of level of CHVs in management of hypertension and diabetes mellitus and subsequent knowledge on symptoms, defining and classifying DM, treatment, prescription of drugs, knowledge of risk factors of DM and prevention of DM at household level.Conclusionsuccess of utilization of community health strategies for diabetes management will require adequate training of CHVs in management of hypertension and diabetes mellitus, financial support of community health units, adequate supervision of community health units, financial support of community health units, provision of tools and commodities and community health units (CHU) utilizing health information system.

Utilizing the Box-Jenkins Time Series Model for Predicting Diarrheal Mortality in Kenya

Utilizing the Box-Jenkins Time Series Model for Predicting Diarrheal Mortality in Kenya

The Quality of Post Abortion Care Package Offered to Women Presenting to Two Referral Hospitals in Bomet County

In 2011, WHO reported 56 million abortions worldwide majority in the developing world. Maternal mortality in Kenya is high at 488/100,000 live births, with abortion related deaths contributing to the top five causes of maternal mortality. The Comprehensive post abortion care package (CPAC), which offers holistic care, has been shown to decrease the rate of maternal mortality and morbidity. This study aims to determine if all the elements of CPAC are offered to women presenting to hospitals in Bomet County. A quantitative Cross-sectional study was undertaken at two referral hospitals in Bomet County. 100 respondents who presented with abortion complications were surveyed in three months with a mean age of 26.6 years. Results indicate poor access to care with 70% accessing care after 24 hours despite life threatening complications. Gaps were noted in contraceptive uptake with only 36% getting a contraceptive at discharge and of these, most were short-term methods. Young people less than 25 years were less likely to be given a contraceptive unlike their counterparts in the faith-based facility OR 0.22(0.06, 0.83) P value <0.02. On spiritual care and emotional counseling, 100% of respondents reported having been emotionally affected by the abortion but only 66% reported care in that area. Only 46% of the patients were tested and counseled for HIV and STIs. Linkage to care was poor indicated by late access to care, there was an improper referral system and inadequacies in follow-up after discharge were also noted. Only 30% of the respondents received the whole CPAC package as required. Results indicate gaps in how frequently the elements of CPAC are provided which affects quality. Efforts need to be put in place to advocate for adherence to CPAC as stipulated in the guidelines with the aim of reducing maternal mortality.

Trends and Determinants of Pregnancy Rate among Adolescents Age 15-19 Years in Kenya: Results from Kenya Demographic Health Survey, 2003-2014, an Opportunity for Surgical Intervention to Reduce Adolescent Maternal Mortality in Kenya

Trends and Determinants of Pregnancy Rate among Adolescents Age 15-19 Years in Kenya: Results from Kenya Demographic Health Survey, 2003-2014, an Opportunity for Surgical Intervention to Reduce Adolescent Maternal Mortality in Kenya

Feasible E-Health Strategies to Reduce Maternal Mortality in Kenya

Maternal mortality remains a persistent cause of death in Sub-Saharan Africa. Although e-health technologies are rapidly advancing, many technologies are infeasible given the infrastructure constraints and context of Sub-Saharan Africa. This paper proposes and implement a feasible e-health strategy, which involves the use of simple mobile phone technology and was designed to reduce maternal mortality and neonatal rates through information dissemination, among the nomadic people within a select part of Kenya. This strategy was developed, through an interactive pilot study, to determine the most feasible technique, which was found to be SMS messages, and most appropriate customized information depending on the patient's condition and period in pregnancy. A cross-sectional randomized e-health intervention was implemented in order to determine the effectiveness of the intervention. Due to exceptional circumstances, such as a prolonged health strike, this intervention had mixed results but shows promise of both feasibility and effectiveness.

Correction: Cost-effectiveness of risk stratified medication management for reducing premature cardiovascular mortality in Kenya.

[This corrects the article DOI: 10.1371/journal.pone.0218256.].

Cesarean delivery and associated socioeconomic factors and neonatal survival outcome in Kenya and Tanzania: analysis of national survey data

ABSTRACT Background: The increasing trends in cesarean delivery are globally acknowledged. However, in many low-resource countries, socioeconomic disparities have created a pattern of underuse and overuse among lower and higher socioeconomic groups. The impact of rising cesarean delivery rates on neonatal survival is also unclear. Objective: To examine cesarean delivery and its associated socioeconomic patterns and neonatal survival outcome in Kenya and Tanzania. Methods: We employed binary logistic regression to analyze cross-sectional demographic and health survey data on neonates born in health facilities in Kenya (2014) and Tanzania (2016). Results: Cesarean delivery rates ranged from 5% among uneducated, rural Tanzanian women to 26% among educated urban women in Kenya to 37.5% among managers in urban Tanzania. Overall findings indicated higher odds of cesarean delivery among mothers from richest households, adjusted odds ratio (aOR) 1.4 (95% CI 1.2–1.8), those insured, aOR 1.6 (95% CI 1.3–1.9), highly educated, aOR 1.6 (95% CI 1.2–2.0) and managers aOR 1.7 (95% CI 1.3–2.2), compared to middle class, no insurance, primary education and unemployed, respectively. Overall, compared to normal births and while adjusting for maternal risk factors, cesarean delivery was significantly associated with neonatal mortality in Kenya and Tanzania, overall aOR 1.7 (95% CI 1.2–2.7). However, statistical significance ceased when fetal risk factors and number of antenatal care visits were further controlled for, aOR 1.6 (95% CI 0.9–2.6). Conclusion: Disproportionate access to cesarean delivery has widened in Kenya and Tanzania. Higher risks of cesarean-related neonatal deaths exist. Medically indicated or not, the safety and/or choice of cesarean delivery is best addressed on individual basis at the health-facility level. However, policy initiatives to eliminate incentives, improve equitable access and accountability to reduce unnecessary cesarean deliveries through well-informed decisions are needed. Efforts to prevent unintended pregnancies among adolescents as well as training of health workers and continuous research to improve neonatal outcomes are vital.