Abstract
IntroductionDespite recent gains, Kenya did not achieve its Millennium Development Goal (MDG) target for reducing under-five mortality. To accelerate progress to 2030, we must understand what impacted mortality throughout the MDG period.MethodsTrends in the under-five mortality rate (U5MR) were analysed using data from nationally representative Demographic and Health Surveys (1989–2014). Comprehensive, mixed-methods analyses of health policies and systems, workforce and health financing were conducted using relevant surveys, government documents and key informant interviews with country experts. A hierarchical multivariable linear regression analysis was undertaken to better understand the proximal determinants of change in U5MR over the MDG period.ResultsU5MR declined by 50% from 1993 to 2014. However, mortality increased between 1990 and 2000, following the introduction of facility user fees and declining coverage of essential interventions. The MDGs, together with Kenya’s political changes in 2003, ushered in a new era of policymaking with a strong focus on children under 5 years of age. External aid for child health quadrupled from 40 million in 2002 to 180 million in 2012, contributing to the dramatic improvement in U5MR throughout the latter half of the MDG period. Our multivariable analysis explained 44% of the decline in U5MR from 2003 to 2014, highlighting maternal literacy, household wealth, sexual and reproductive health and maternal and infant nutrition as important contributing factors. Children living in Nairobi had higher odds of child mortality relative to children living in other regions of Kenya.ConclusionsTo attain the Sustainable Development Goal targets for child health, Kenya must uphold its current momentum. For equitable access to health services, user fees must not be reintroduced in public facilities. Support for maternal nutrition and reproductive health should be prioritised, and Kenya should acknowledge its changing demographics in order to effectively manage the escalating burden of poor health among the urban poor.
Subject
Public Health, Environmental and Occupational Health,Health Policy
Reference67 articles.
1. The UN Inter-Agency Group for Child Mortality Estimation. 2015 http://www.childmortality.org/index.php?r=site/graph - ID=KEN_Kenya (accessed Aug 2015).
2. Kenya National Bureau of Statistics, ICF Macro. Kenya Demographic and Health Survey 2014: Nairobi, 2015.
3. Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study;Keats;Lancet Glob Health,2017
4. Singh NS , Huicho L , Afnan-Holmes H , et al . Countdown to 2015 country case studies: systematic tools to address the "black box" of health systems and policy assessment. BMC Public Health 2016;16(Suppl 2):790.doi:10.1186/s12889-016-3402-5
5. National Council for Population and Development, Institute for Resource Development/Macro Systems. Kenya Demographic and Health Survey 1989: Ministry of Home Affairs and National Heritage, ed. Nairobi, 1989.
Cited by
25 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献