Academic journal article International Journal of Population Research

Mortality Decline in Kenya: A Reexamination of Recent Under-Five Mortality Estimate

Academic journal article International Journal of Population Research

Mortality Decline in Kenya: A Reexamination of Recent Under-Five Mortality Estimate

Article excerpt

George Odwe 1 and Anne Khasakhala 1 and Titus Agwanda 1 and Andrew Imbwaga 2 and Zena Lyaga 1

Academic Editor:Pranitha Maharaj

1, University of Nairobi, P.O. Box 30197, Nairobi 00100, Kenya 2, Kenya National Bureau of Statistics, P.O. Box 30266, Nairobi 00100, Kenya

Received 28 January 2015; Revised 15 June 2015; Accepted 18 June 2015; 9 July 2015

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

Kenya enjoyed a rather impressive and sustained decline in the under-five mortality rate (sum of all deaths that occur to children who were born alive but did not survive until their fifth birthday) of 3 percent to 4 percent per annum during the period from 1965 to 1980 [1]. The decline was almost twice the rate of the average country of Sub-Saharan Africa during this period. However, the decline was slowed to about 2 percent in the 1980s. The 1998 Kenya Demographic and Health Survey (KDHS) provided the first clear evidence that the decline not only had slowed but also had been reversed during the 1990s [2]. Data obtained from birth histories indicated a 24 percent increase in the under-five mortality rate from the mid-1980s to the mid-1990s with enormous regional differentials. However, the 2008/9 KDHS showed a reversal in the levels and differentials of under-five mortality rate during the 1990s and early 2000. The under-five mortality rate for five-year periods preceding the survey declined by 36 percent from 115 deaths per 1000 to 74 deaths per 1000. Infant mortality declined by 32 percent during the same period [3]. For the first time infant mortality (deaths that occur before the first year of life) was higher in urban areas compared to rural areas while infants for mothers with no education were less likely to die compared to women with some slight primary level of education. The remarkable decline in the observed level of childhood mortality rates was widely attributed to the efforts by the government to improve health services [4]. Nevertheless, questions emerge from these observations on whether the observed rapid change in under-five mortality patterns is an artifact of data or a result of changes in the factors influencing mortality regimes.

These questions raise another important issue on whether the remarkable decline in under-five mortality in Kenya was real. The substantial decline in the levels of childhood mortality reported in 2008/9 KDHS requires further scrutiny to establish the reliability of the mortality estimates. Accurate measurement of under-five mortality rate is fundamental as an indicator of population health and has always been used to track development progress of a country [5, 6]. Indeed major health programmes and initiatives are centered on under-5 mortality. The UN Millennium Development Goals (MDG) agreed by most UN member states in 2000 set a target of reducing the under-5 mortality rate by two-thirds by 2015. The probability of dying before age 5 denoted by 5 q 0 is an important input parameter in the computation of mortality indicators such as life expectancy for developing countries without reliable vital registration system such as Kenya.

Given that Kenya still lacks reliable vital registration system, the childhood mortality estimates are largely derived from the Demographic and Health Survey (DHS). The DHS calculates the under-five mortality from retrospective reproductive histories information as reported by female respondents aged 15-49 years [7]. As a result, DHS is prone to sampling and coverage errors especially on the data on dates which could affect fertility and mortality estimates. This study examines whether the remarkable decline in under-five mortality in Kenya recorded in 2008/09 KDHS is real or an artifact of measurement. We compare the extent of birth displacement and its effect on under-five mortality rate by socioeconomic characteristics (place of residence and region) using 2003 and 2008/09 Kenya DHSs. …

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