Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014
Background To improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors a...
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BMJ Publishing Group
2021-04-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/6/4/e004544.full |
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| author | Benn Sartorius Peter M Macharia Robert W Snow Noel K Joseph Emelda A Okiro |
| author_facet | Benn Sartorius Peter M Macharia Robert W Snow Noel K Joseph Emelda A Okiro |
| author_sort | Benn Sartorius |
| collection | DOAJ |
| description | Background To improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors associated with child survival while elucidating areas of progress, stagnation and decline in Kenya.Methods Twenty household surveys and three population censuses conducted since 1989 were assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatio-temporal Gaussian process regression models accounting for inadequate sample size and spatio-temporal relatedness were fitted for 43 factors at county level between 1993 and 2014.Results Nationally, the coverage and prevalence were highly variable with 38 factors recording an improvement. The absolute percentage change (1993–2014) was heterogeneous ranging between 1% and 898%. At the county level, the estimates varied across space and over time with a majority showing improvements after 2008 which was preceded by a period of deterioration (late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya had and historically have had higher coverage across all intervention domains. Most factors in Western and South-East Kenya recorded moderate intervention coverage although having a high infection prevalence of both HIV and malaria.Conclusion The heterogeneous estimates necessitates prioritisation of the marginalised counties to achieve health equity and improve child survival uniformly across the country. Efforts are required to narrow the gap between counties across all the drivers of child survival. The generated estimates will facilitate improved benchmarking and establish a baseline for monitoring child development goals at subnational level. |
| format | Article |
| id | doaj-art-fb455b91d77a4949bdc4a44fe08d6341 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2021-04-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-fb455b91d77a4949bdc4a44fe08d63412024-12-05T16:20:08ZengBMJ Publishing GroupBMJ Global Health2059-79082021-04-016410.1136/bmjgh-2020-004544Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014Benn Sartorius0Peter M Macharia1Robert W Snow2Noel K Joseph3Emelda A Okiro4Centre for Tropical Medicine and Global Health,Nuffield Department of medicine, University of Oxford, Oxford, UK3 Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya4 Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK1 Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, KenyaPopulation Health Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, KenyaBackground To improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors associated with child survival while elucidating areas of progress, stagnation and decline in Kenya.Methods Twenty household surveys and three population censuses conducted since 1989 were assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatio-temporal Gaussian process regression models accounting for inadequate sample size and spatio-temporal relatedness were fitted for 43 factors at county level between 1993 and 2014.Results Nationally, the coverage and prevalence were highly variable with 38 factors recording an improvement. The absolute percentage change (1993–2014) was heterogeneous ranging between 1% and 898%. At the county level, the estimates varied across space and over time with a majority showing improvements after 2008 which was preceded by a period of deterioration (late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya had and historically have had higher coverage across all intervention domains. Most factors in Western and South-East Kenya recorded moderate intervention coverage although having a high infection prevalence of both HIV and malaria.Conclusion The heterogeneous estimates necessitates prioritisation of the marginalised counties to achieve health equity and improve child survival uniformly across the country. Efforts are required to narrow the gap between counties across all the drivers of child survival. The generated estimates will facilitate improved benchmarking and establish a baseline for monitoring child development goals at subnational level.https://gh.bmj.com/content/6/4/e004544.full |
| spellingShingle | Benn Sartorius Peter M Macharia Robert W Snow Noel K Joseph Emelda A Okiro Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014 BMJ Global Health |
| title | Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014 |
| title_full | Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014 |
| title_fullStr | Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014 |
| title_full_unstemmed | Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014 |
| title_short | Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014 |
| title_sort | subnational estimates of factors associated with under five mortality in kenya a spatio temporal analysis 1993 2014 |
| url | https://gh.bmj.com/content/6/4/e004544.full |
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