Ondolo, Henry Abraham Ochieng; (1997) A study of regional determinants of mortality differentials in children (Kenya). Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

A community-based study of Regional Determinants of Mortality Differentials in Children, was conducted in 1994 in 4 randomly selected communities in two neighbouring districts of Homa Bay and Kisii in Nyanza Province, Kenya. Aim: to investigate why child mortality differentials exist between and within the districts of Kenya which have identical infrastructures for the delivery of social services. Methodology: Data was collected by retrospective recall on the reproductive health of women of child bearing age and the health of their children born within five years prior to the study. Concurrent data was collected on the same children, their parents and household. Secondary data was used to describe the environmental conditions. Result: The study established that for the period covered by the study (1989-1994) child mortality differential of 2.3 fold exists between the two districts (1.7 fold between communities in the high mortality district and 2 fold in the low child mortality district). The largest difference recorded in the study was 4.5 fold between two communities with the highest and lowest child mortality. Among the infants which accounted for 67% of all child deaths, the differential was 9.7 fold between the two communities. Measles, malaria and tetanus emerged as the major causes of death in the highest mortality community but none of them was reported in lowest mortality area. Mortality rates were inversely related to the altitudes of the study communities. The socioeconomic, cultural and demographic factors, which were significantly associated with child mortality are the number of children born to a mother in five years, age at marriage, age at first delivery, place of last delivery and level of education (all maternal factors); father's income level; ownership of radio; and presence of a toilet in the compound. In high mortality community where multiple infections acted synergistically, the risk of child death increased by 8 times if the mother experienced 3-4 compared to those with 1-2. live births in five years. Conclusions: Currently there is no documented information-on child mortality at the sub-district level for informed decision about effective interventions on child mortality; there are synergistic interactions between environmental, socioeconomic, cultural and demographic determinants of child mortality on one hand and infections on the other; and the most important infections are measles, malaria and tetanus. Recommendations: There is need for: complete and accurate birth and death certification, including cause of death desegregated by local area; intensive supervision of immunization programme to achieve coverage rates of 80% and above; inter-disciplinary district-wide surveys to generate local area statistics for assessment of health and economic status in order to identify high risk communities and to monitor trend of change; further surveys in areas of high mortality to identify possible contributory factors; to set short- and long-term goals to address the emerging socioeconomic, demographic and cultural factors relevant to the improvement of the health of the mothers and children in various communities; and re-orientation and re-organization towards a "People-centred Health Policy" which focuses on the determinants of the common endemic diseases. In such a policy the emphasis will be on public information as much as on medical interventions, especially for preventable diseases.

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