Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study

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.

Social judgments on abortion and contraceptive use: a mixed methods study among secondary school teachers and student peer-counsellors in western Kenya

“…Kenya has a young population with an estimated 10.5 million adolescents aged 10-19 years, corresponding to 22.5% of the country's total population [12]. The maternal mortality ratio has been declining during the last decade to reach 510 in 2015 [13]. Since 2010, a revised abortion law in Kenya allow abortion when the life or health of a woman is in danger [14].…”

“…Since 2010, a revised abortion law in Kenya allow abortion when the life or health of a woman is in danger [14]. Still, unsafe abortion remains the leading cause of maternal deaths in adolescent girls [13]. The contraceptive prevalence rate has increased steadily to 61.6 among married women aged 15-49 years in 2016 [15].…”

Morbidities and mortality among infants of HIV-1-infected mothers with bacterial vaginosis in Kenya

“…Several authors have cited the importance of a mother's care and Nduati et al (14) reported higher mortality and morbidity rates among children whose mothers had died. Therefore, it is common knowledge that maternal health is an important determinant of infant health (16,26). Since our work focuses on infant survival and wellbeing, it is inevitable to consider the aspect of maternal health as the two are interlinked.…”

District level inequality in reproductive, maternal, neonatal and child health coverage in India

“…The 2015 countdown analysis, replaced by the countdown 2030, annually monitors the progress in the coverage indicators of the countdown countries at the national level [6,8,16]. Though there has been substantial progress achieved by many countries, the achievement was uneven and need more significant acceleration [6,[17][18][19][20][21]. Concerns about health inequity indicate that there is a need for analysis of health indicators at the microgeographic level or the population subgroups.…”