Trends in childhood mortality in Kenya: the urban advantage has seemingly been wiped out

Background: we describe trends in childhood mortality in Kenya, paying attention to the urban–rural and intra-urban differentials.Methods: we use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR).Results: between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban–rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya.Conclusions: the narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums

Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya

Poor breastfeeding practices are widely documented in Kenya, where only a third of children are exclusively breastfed for 6 months and only 2% in urban poor settings. This study aimed to better understand the factors that contribute to poor breastfeeding practices in two urban slums in Nairobi, Kenya. In-depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with women of childbearing age, community health workers, village elders and community leaders and other knowledgeable people in the community. A total of 19 IDIs, 10 FGDs and 11 KIIs were conducted, and were recorded and transcribed verbatim. Data were coded in NVIVO and analysed thematically. We found that there was general awareness regarding optimal breastfeeding practices, but the knowledge was not translated into practice, leading to suboptimal breastfeeding practices. A number of social and structural barriers to optimal breastfeeding were identified: (1) poverty, livelihood and living arrangements; (2) early and single motherhood; (3) poor social and professional support; (4) poor knowledge, myths and misconceptions; (5) HIV; and (6) unintended pregnancies. The most salient of the factors emerged as livelihoods, whereby women have to resume work shortly after delivery and work for long hours, leaving them unable to breastfeed optimally. Women in urban poor settings face an extremely complex situation with regard to breastfeeding due to multiple challenges and risk behaviours often dictated to them by their circumstances. Macro-level policies and interventions that consider the ecological setting are needed

Appropriateness of user fees for reproductive health services in Malawi

Demand for heath services is increasing inmany African countries, particularly thoseaffected by HIV/AIDS. Sub-Saharan Africais experiencing the long-awaiteddemographic transition leading to anincrease in demand for contraceptiveservices and STI treatment facilities. Healthservices are strained due to increasingpopulation and declining public spending onhealth services. Introducing cost sharingmeasures is one solution for healthproviders to recover cost and generaterevenue to expand provision

Birth spacing in Malawi and its impact on under five mortality

SIGLEAvailable from British Library Document Supply Centre- DSC:DX176107 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Determinants of infant mortality in Malawi: an analysis to control for death clustering within families

Two logistic binomial models for neonatal mortality (under 1 month) and post-neonatal mortality were used to determine the probability of dying among families in Malawi. Data was obtained from 3043 women aged 15-54 years on 6258 births, which occurred 0-15 years before the survey, from the 1988 Malawi Traditional and Modern Methods of Child Spacing Survey. Mortality included 211 post-neonatal deaths, 147 toddler deaths, and 172 child deaths. Missing information or date of death missing information pertained to 182 reported deaths that were excluded from the analysis. Logistic models were run with the complete sample and the sub-sample and found to have similar results. Findings showed that children born in homes with electricity had 34% lower risk of dying than children born in homes without electricity. Preceding birth interval was unrelated to neonatal mortality. Neonatal mortality rates were significantly higher in Chiradzulu rural area, which was found to have a lower proportion of mothers with five or more years of education. The random term, which was high, suggested a high familial correlation with neonatal mortality risk. Findings showed that families with favorable characteristics living in the Chiradzulu area had a probability of 0.005 of a neonatal death. Low risk families in unfavorable circumstances had lower probabilities of child loss than high risk families with favorable conditions. Significant determinants of post-neonatal mortality were preceding birth interval, maternal education, father's occupation, and geographic area. Women with 9 or more years of education had lower infant mortality risks. Family effects were significant, even after controlling for socioeconomic conditions. The most favorable conditions for child survival were: no preceding child; a preceding birth interval of 19 months or longer; maternal education of 9 or more years; and paternal employment in non-manual work

Child malnutrition and feeding practices in Malawi

The 1992 Malawi and Demographic Health Survey data are used to assess the association between breast-feeding practices, socio-economic and morbidity variables, and the nutritional status of children under the age of five years using multilevel models. About 27% of under-five children in Malawi are underweight, and nearly 50% are stunted. The results of this study suggest that socio-economic factors, morbidity, and inappropriate feeding practices are some of the factors associated with malnutrition in Malawi. High socio-economic status, as measured by urban residence, the presence of modern amenities, and some maternal education, is associated with better nutritional status, whereas morbidity within two weeks before the survey is associated with low weight-for-age Z scores. Breast-feeding is almost universal and is carried on for about 21 months, but the introduction of complementary food starts much too early; only 3% of Malawian children under the age of 4 months are exclusively breastfed. Children aged 12 months or older who were still breastfeeding at the time of the survey were of lower nutritional status than those who had stopped breastfeeding. The analysis also showed a significant intra-family correlation of weight-for-age Z scores of children of the same family of about 39%

Poverty linked to early sexual debut and low condom use in Africa [Digest]

The findings indicate that in parts of Sub-Saharan Africa, poverty is associated with early sexual debut (particularly among females) and that the poor are less likely than their wealthier peers to use condoms. Thus, the researchers note, it seems likely that "poverty, by influencing sexual behavior and access to services, can influence the transmission of HIV infection.

A tale of two continents Explanations for death clustering in India and Africa

Period of award: 1 year. Includes bibliographical references. Title from covering page: A tale of two continents: seeking an explanation for clustering of infant deaths within African and Indian familiesAvailable from British Library Document Supply Centre- DSC:3739. 0605(000223400) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo