Sub-national variation in indicators of maternal mortality in Kenya requires targeted interventions to fast-track SDG attainment

Abstract

Abstract Background One in four deaths among females of reproductive age is maternal or pregnancy related, thereby making maternal mortality a major global health concern. A disproportionate number of these deaths occur in developing countries. In Kenya, maternal mortality ratio (MMR) has declined from 708 to 378 deaths per 100,000 live births between 2000 and 2021. However, the Sustainable Development Goal (SDG-3.1) target is to reduce global MMR to less than 70 deaths per 100,000 live births by 2030. Here, we quantify and highlight indicators that contribute to differentiated MMR across different geographic regions in Kenya. We anticipate that this will inform targeted interventions and resource allocation for each specific region and fast-track SDG-3 attainment. Methods We leveraged data from the demographic and health survey for Kenya. The correlation in the patterns of the indicators and MMR across the counties and the regions was analyzed and the cumulative contribution by multiple indicators for each county was determined. We then compared the performance of the regions to the national average by calculating the rate ratios. Results Our results highlight how variation in socio-demographic characteristics influence maternal mortality rates across Kenya. We observed a high antenatal clinic attendance rate, but on the contrary very low rates of uptake of modern contraceptives. Infectious diseases (Malaria, TB, and HIV) exhibited an overlap in geographic distribution in coastal counties and counties around lakes. There was a significant correlation between prevalence of malaria and HIV (Pearson’s correlation coefficient r = 0.59), and a moderate positive correlation between prevalence of HIV and TB (Pearson’s correlation coefficient r = 0.41). Gender-based violence during pregnancy was highest in an urban setting (18.1%), and lowest in marginalized rural areas (2.7%). Female genital mutilation had higher rates among those who practice Islam (51.1%), live in rural settings (25.9%), with no education (13%), and in the lowest wealth quintile (6.2%). Conclusion These findings suggest a wide spectrum of direct, indirect, cultural and socio-economic factors collectively contributing to elevated MMR. We disaggregate sub-national disparities and highlight that customized interventions for different sub-populations are required to curtail maternal mortality, and accelerate the attainment of the SDG-3.1 target.