Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study
Background: Progress 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 a...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2017-08-01
|
| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X17302462 |
| _version_ | 1817984953695076352 |
|---|---|
| author | Emily C Keats, PhD Anthony Ngugi, PhD William Macharia, MMed Nadia Akseer, MSc Emma Nelima Khaemba, MSc Zaid Bhatti, MSc Arjumand Rizvi, MSc John Tole, MMed Prof Zulfiqar A Bhutta, PhD |
| author_facet | Emily C Keats, PhD Anthony Ngugi, PhD William Macharia, MMed Nadia Akseer, MSc Emma Nelima Khaemba, MSc Zaid Bhatti, MSc Arjumand Rizvi, MSc John Tole, MMed Prof Zulfiqar A Bhutta, PhD |
| author_sort | Emily C Keats, PhD |
| collection | DOAJ |
| description | Background: Progress 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.
Methods: We 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.
Findings: After 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.
Interpretation: Intensified 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.
Funding: US Fund for UNICEF, Bill & Melinda Gates Foundation. |
| first_indexed | 2024-04-13T23:50:58Z |
| format | Article |
| id | doaj.art-b16e8c423eb5473592383423ef642dd7 |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-04-13T23:50:58Z |
| publishDate | 2017-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-b16e8c423eb5473592383423ef642dd72022-12-22T02:24:05ZengElsevierThe Lancet Global Health2214-109X2017-08-0158e782e79510.1016/S2214-109X(17)30246-2Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case studyEmily C Keats, PhDAnthony Ngugi, PhDWilliam Macharia, MMedNadia Akseer, MScEmma Nelima Khaemba, MScZaid Bhatti, MScArjumand Rizvi, MScJohn Tole, MMedProf Zulfiqar A Bhutta, PhDBackground: Progress 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. Methods: We 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. Findings: After 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. Interpretation: Intensified 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. Funding: US Fund for UNICEF, Bill & Melinda Gates Foundation.http://www.sciencedirect.com/science/article/pii/S2214109X17302462 |
| spellingShingle | Emily C Keats, PhD Anthony Ngugi, PhD William Macharia, MMed Nadia Akseer, MSc Emma Nelima Khaemba, MSc Zaid Bhatti, MSc Arjumand Rizvi, MSc John Tole, MMed Prof Zulfiqar A Bhutta, PhD Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study The Lancet Global Health |
| title | Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study |
| title_full | Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study |
| title_fullStr | Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study |
| title_full_unstemmed | Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study |
| title_short | Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study |
| title_sort | progress and priorities for reproductive maternal newborn and child health in kenya a countdown to 2015 country case study |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X17302462 |
| work_keys_str_mv | AT emilyckeatsphd progressandprioritiesforreproductivematernalnewbornandchildhealthinkenyaacountdownto2015countrycasestudy AT anthonyngugiphd progressandprioritiesforreproductivematernalnewbornandchildhealthinkenyaacountdownto2015countrycasestudy AT williammachariammed progressandprioritiesforreproductivematernalnewbornandchildhealthinkenyaacountdownto2015countrycasestudy AT nadiaakseermsc progressandprioritiesforreproductivematernalnewbornandchildhealthinkenyaacountdownto2015countrycasestudy AT emmanelimakhaembamsc progressandprioritiesforreproductivematernalnewbornandchildhealthinkenyaacountdownto2015countrycasestudy AT zaidbhattimsc progressandprioritiesforreproductivematernalnewbornandchildhealthinkenyaacountdownto2015countrycasestudy AT arjumandrizvimsc progressandprioritiesforreproductivematernalnewbornandchildhealthinkenyaacountdownto2015countrycasestudy AT johntolemmed progressandprioritiesforreproductivematernalnewbornandchildhealthinkenyaacountdownto2015countrycasestudy AT profzulfiqarabhuttaphd progressandprioritiesforreproductivematernalnewbornandchildhealthinkenyaacountdownto2015countrycasestudy |