Trends and Determinants of Neonatal Mortality in Kenya Analysis of the Kenya Demographic Health Survey 1998-2014 and a Validation Study within Nakuru Municipality

Abstract

Globally, there has been a marked decline in neonatal mortality and overall child mortality indicators from 1990 to date. In Kenya, however, neonatal deaths contribute to 40% of under-five mortality rates (U5MR) making it an important health priority. This study analysed trends and determinants of neonatal mortality in Kenya from 1998 to 2014 utilizing data from the Kenya Demographic and Health Surveys (KDHS) and primary data from a study at the Nakuru Level 6 Hospital. Study results from logistic regression analysis showed that mother’s wealth status was a significant predictor of neonatal morality as mothers from the poorest households had higher odds of neonatal deaths (OR=1.9, p=0.015, CI=95%) in 2003 and (OR=1.09, p=0.0046) in 2014. The study found that level of education was a significant predictor of neonatal deaths. In the analysis conducted in 2003, mothers with primary education had twice the likelihood of losing their infants in the neonatal period (OR=2.06, p=0.037, CI=95%). This trend continued in 2008 (OR=2.15, p=0.01, CI=95%) and 2014 (OR=3.127, p=0.014, CI=95%). Additionally, infants born with low birth weight (LBW) had a higher risk of death within the first 28 days. The results from 2003 showed an odds ratio of (OR=23.08 p=0.006, CI=95%), while in 2008 it was (OR=18.216, p=0.042, CI=95%), and in 2014 it was (OR=9.59, p=0.04, CI=95%), compared to neonates weighing more than 3.5 kilograms at birth. Mothers who delivered in hospitals had a lower likelihood of neonatal deaths (OR=0.78, p=0.012, CI=95%) in 1998 and (OR=0.062, p=0.043, CI=95%) in 2008 compared to mothers who delivered at home. Mothers who did not attend ANC during pregnancy were 5 times more likely to experience neonatal deaths (OR=5.571, p=0.005, CI=95%) in 1998, (OR= 2.163, p=0.033, CI=95%) in 2008 and (OR=9.636, 0.027, CI=95%) in 2014 compared to mothers who attained the recommended >4 ANC visits. Based on analysis of the primary data collected in Nakuru, low birth weight emerged as a significant predictor of neonatal deaths. The study therefore recommends prioritization of enhancement of maternal health and nutrition education during pregnancy to reduce incidences of low birth weight through increased antenatal visits. Additionally, implementing universal health care and promoting sustained community referrals can encourage hospital deliveries and decrease the occurrence of new-born deaths due to complications that may arise after birth. Emphasizing girls' education is also crucial in ameliorating the adverse effects of low mother literacy on neonatal survival