A reversal in reductions of child mortality in western Kenya, 2003-2009

Abstract

We report and explore changes in child mortality in a rural area of Kenya during 2003-2009, when major public health interventions were scaled-up. Mortality ratios and rates were calculated by using the Kenya Medical Research Institute/Centers for Disease Control and Prevention Demographic Surveillance System. Inpatient and outpatient morbidity and mortality, and verbal autopsy data were analyzed. Mortality ratios for children less than five years of age decreased from 241 to 137 deaths/1,000 live-births in 2003 and 2007 respectively. In 2008, they increased to 212 deaths/1,000 live-births. Mortality remained elevated during the first 8 months of 2009 compared with 2006 and 2007. Malaria and/or anemia accounted for the greatest increases in child mortality. Stock-outs of essential antimalarial drugs during a time of increased malaria transmission and disruption of services during civil unrest may have contributed to increased mortality in 2008-2009. To maintain gains in child survival, implementation of good policies and effective interventions must be complemented by reliable supply and access to clinical services and essential drugs.

Conflict of interest statement

Disclosure: None of the authors have any conflicts of interest.

Figures

Figure 1.

All cause childhood mortality in the Kenya Medical Research Institute/Centers for Disease Control and Prevention Health and Demographic Surveillance System, 2003–2008.

Figure 2.

Verbal autopsy cause-specific under-five mortality rates, (excluding the neonatal period of 0–28 days of life), Kenya Medical Research Institute/Centers for Disease Control and Prevention Health and Demographic Surveillance System, 2003–2008.

Figure 3.

Under-five mortality Siaya District Hospital, Kenya, 2003–2009.

Figure 4.

A, Children under-five admitted malaria blood smear positive, Siaya District Hospital, Kenya, 2003–2009. B, Children under-five presenting malaria blood smear positive, Lwak Mission Hospital, Kenya, July 2006–December 2009.

Figure 5.

Trends in Plasmodium falciparum and anemia prevalence in children less than five years of age, Kenya Medical Research Institute/Centers for Disease Control and Prevention Health and Demographic Surveillance System, 2003–2009.