Where mothers, children are likely to die early

Kenya continues to make strides in the area of child delivery, with increased government investment in healthcare allowing mothers such as Lydia Wairimu, a mother of two from Nairobi, to deliver their babies at health facilities as opposed to home deliveries.

For Lydia and thousands of other Kenyan mothers, delivering in a health facility means not only better care for her and her baby in the hands of medical professionals but a lower risk of birth complications for them as well.

This 27-year-old mother was among the one million mothers in Kenya who had normal deliveries in 2021, compared to only 754,000 in 2017 – a 35 per cent increase. These births represent 85 per cent of all births that occurred last year, according to the just-released 2022 Economic Survey.

Meanwhile, the number of women delivering through cesarean-section in the country continues to grow steadily, with 201,000 of them giving birth via this method, compared to 130,000 five years ago.

Use of modern contraception
The popularity and uptake of modern contraception has continued to grow among Kenyan mothers, with many women practising family planning. Before her delivery last year, Lydia had been on contraceptives for five years, allowing her to space out her children.

Among the different forms of contraception in health facilities in Kenya, family planning (FP) injections are the most popular, with 2.4 million women having taken the injection last year. Out of these, 595,000 women took the FP injection for the first time in 2021.

The uptake of oral contraceptives remains steady among Kenyan mothers, having grown from 289,000 in 2017 to 700,000 in 2011.

Use of intrauterine contraceptive device insertion, however, has been fluctuating over the past five years. A total of 218,000 women used this method in 2017 compared to only 107,000 last year. It is this method that Lydia has been using.

Fertility
If Lydia were living in Nairobi, she would have a maximum of 2.5 children in her lifetime, which is the lowest fertility rate in Kenya. She would likely have been married at 23.7 years if she were a resident of Kenya’s capital, according to the findings of the survey.

Lydia’s fertility rate, though, would have been slightly higher at 2.7 children if she were living in Nyamira, Machakos, Kiambu and Kirinyaga counties.

But if she were living in Mandera County, the mother of two would most likely have eight children. In this county that has the highest fertility rate, the average age for marriage for women is 21.4 years.

Lydia would also have either seven, 6.4 or 6.7 children if she were living in Marsabit, Turkana and Wajir counties respectively, where the fertility rate is also high.

Life expectancy
Government statistics show that women in Kenya outlive their male counterparts. Based on these estimates, Lydia’s life expectancy at birth was 66.5years, higher than a Kenyan man’s life expectancy of 60.6 years.

Curiously, though, she would die earlier than the average male if she were from Isiolo County. In this county in Northern Kenya, men live longer than women, the only county with such trends in the country.

Let’s suppose Lydia were from Nyeri County. In this county with the highest life expectancy for women in Kenya, she would have a long life of 75.8 years.

Not so if she were from Tana River County. In this coastal county with the lowest life expectancy in the country, she would only live for 58.6 years. She would also live for fewer years if she were from either Turkana or Kilifi, owing to the hardships in these counties.

According to findings of the Economic Survey, Lydia is likely to live for an additional 17.2 years after attaining the age of 60, higher than the 14 additional years that any Kenyan man is likely to live for. This is called ‘‘expectation of life at 60’’, which is the average number of years that a person who has attained age 60 is expected to live, with age-specific mortality levels remaining constant.

Mortality
If Lydia were from Garissa, she would likely be among the 641 maternal deaths that occur in each 100,000 live births in this county, the highest in the country. In Kenya, six counties have a maternal mortality ratio above 500 maternal deaths per 100,000 live births, underscoring this as a health risk for Lydia and other mothers in the country.

The likelihood of this mother dying while giving birth is lowest in Nyeri County. In this Central Kenya county, only 67 mothers die in every 100,000 live births. This falls within the recommended Sustainable Development Goal target of less than 70 maternal deaths per 100,000 live births.

She also stands a fairly decent chance of surviving childbirth in the counties of Mombasa, Kiambu and Laikipia, where the maternal mortality ratio is lower at 190, 171 and 182 deaths respectively.

Migration
Data from the Kenya National Population and Housing census of 2019 shows that more women than men move into other counties.

In Kenya, ease of access for quality healthcare facilities, a higher life expectancy and lower mortality rate is one of the reasons mothers such as Lydia move from some counties to others. In Nairobi, where Lydia lives, more than 345,000 women have recently moved from other counties, thanks to the improved health infrastructure.

Away from Kenya’s capital, Lydia is also likely to move to and settle in either Kiambu or Mombasa, both which score well on these parameters. About 89,000 and 175,000 women moved to Mombasa and Kiambu in that order in the recent past.

Morbidity
In 2021, disease of the respiratory system was the biggest cause of illness in Kenya at 20 million cases, translating to 21 per cent of all infections in the country, and a sharp rise from 14 million in 2017. Malaria (14 million), skin diseases (3.6 million) and diarrhoea (3.2 million) were second, third and fourth in that order.

Death registration
In 2021, women accounted for 100,000, or 43 per cent of all deaths registered in Kenya. According to data from the Economic Survey, registration of deaths among women has remained below 45 per cent in the last five years, an indication that more men than women have been dying in Kenya. More men than women have died in each age bracket in the last five years. It is only among people aged 75 and older, where more women (29,900) than men (28,065) died in 2021.

Overall, 121,000 of the deaths registered last year occurred in health facilities while 11,000 occurred at home.

The role of mothers such as Lydia in the Kenyan family setup cannot be overstated. By last year, there were more than 219,000 women caregivers in Kenya, compared to only 55,000 male caregivers.

Birth registration
In 2021, about 1.2 million births were registered across the country, up from 1.1 registered the previous years. This translates to 86 per cent of all births in Kenya, a significant rise from 83 per cent that were recorded in 2020.

In terms of age distribution of all registered births in Kenya, the report shows that most deliveries (30 per cent) were by mothers aged between 20 and 24 years, indicating preference among Kenyans to start families early. The age bracket of 25 to 29 years, where Lydia falls, is also popular for mothers wishing to bear children, with births in this cohort accounting for 25 per cent of all registered births in Kenya.

From the report, 11 per cent of births registered in Kenya were by mothers aged between 15 and 19 years, while mothers below 15 gave birth to 0.3 of those registered. Only 8.6 per cent of women aged between 35 and 39 years are giving birth, findings of the report show.

In Kenya, most registered births are by married women such as Lydia at 85 per cent while 13 per cent are by single mothers. The report shows that divorced mothers and widowed ones are also having children, each accounting for 0.1 per cent of all registered births.

Children aged under five years in lower and middle countries are exposed to multiple risks including poverty, malnutrition, poor health and an unfavourable growing environment which later affect their development and well-being. 

From the just-released 2022 Economic Survey, genetics, environmental influences, parenting styles and the culture at large are just some of the major factors that combine in unique ways to determine how a child develops and the person they will one day become. 

From the survey, Healthy Nation identified 10 factors with available data to tell a story of an infant growing up in Kenya and how this will pan out his/her development potential.

Using the data from the survey, Healthy Nation traced a two-day-old child, Scholastica, to tell a story of what lies ahead for children born in Kenya. 

With the disconnect between the urban and the rural children, the disadvantaged children are likely to have poor health outcomes, do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children.

What stories will the development and growth indicators say about Kenyan children? 

Scholastica, if born in Nairobi, is likely to live for 67 years, but her male counterparts will live for only 61 years. 

However, had Scholastica been born in Isiolo, she would likely die earlier than her male counterparts as well as in Tana River, which had the lowest life expectancy for females at 59. 

Had her mother given birth to her in Nyeri, which had the highest life expectancy for women, Scholastica would live for 76 years. However, given the environment and county where she was born, if all goes well, she will live for 65 years. 

Hospital delivery
Given that they stay in an urban setup, she is lucky that she was delivered in a hospital unlike others living in the rural and arid and semi-arid counties whose mothers give birth at home. 

From the data, deliveries in health facilities in 2021 increased by 5.7 per cent to 1.2 million in 2021, with normal deliveries accounting for 82.4 per cent of total deliveries. 
This means that when delivery is done in a hospital, children including Scholastica will get their first immunisation and are likely to survive in case their mother develops a complication, unlike home delivery where a complication results in unplanned mortality. 

Birth Registration 
Having been born in a facility, her details are likely to be registered in the government system. This will give her an easy time to get her birth certificates unlike other children who will be born at home and have to do follow-ups to get documented 

The survey indicates that there were slightly more male births registered than female births between 2017 and 2021. Male registered births accounted for 51 per cent of births compared to 49 per cent for females in 2021. 

Infant mortality 
When Scholastica was born this month, the country’s infant mortality stood at 35.5 deaths per 1,000 live births while under-five mortality was 52 deaths per 1,000 live births. In Nairobi, where she was born, infant death is 36 deaths per 1,000 live births 

However, should the family relocate to Migori County, which has the highest infant mortality rate at 67.2 per 1,000 live births, followed by Homa Bay at 57.5 per 1,000 live births, she is likely to die early as an infant. Migori also has the highest under-five deaths at 107.2 per 1,000 live births. 

Schooling
If she is lucky and continues living in Nairobi and the family does not relocate to the village, Scholastica will join the pre-primary school at the age of four. By her sixth birthday, she will have joined Grade One and will be expected to finish primary school by the age of 13. 

If they relocate to the village at this point, she might not be able to finish her education and the priority will be given to her brothers. She will probably be expectant by the time she gets to secondary school while others continue with their education. 

Reproductive history  
If she manages to grow up in Nairobi, which is an urban setup, she is likely to have her first sexual intercourse at the age of 19 and give birth to her first baby at the age of 22, a disconnect from her rural age mates who would have their first intercourse at 17 and get married at 20 years, give birth at 20 years and use their first family planning method at 22 years. 

For the males, the earliest they can get married when they are in the urban setup is 24 years, unlike their rural age mates who marry when they are still in school at 18 years. 

Number of children
If Scholastica were staying in Mandera, Wajir, and Marsabit counties, she would be more likely to give birth to at least seven children even with the national fertility rate estimated at three children per woman.
Now that she is living in Nairobi, she is likely to give birth to only two children. Should she relocate to Nyamira, Kiambu, Kirinyaga, and Machakos, then she will be giving birth to only one child since they have the lowest fertility rate in the country.

From the findings of the survey, the Singulate Mean Age at Marriage (SMAM) was 27.3 years for males and 23.1 years for females.

The SMAM is an indicator of the timing of the first marriage. Young people have lately been delaying entry into marriage, with males taking their time before they get into marriage than females.

Use of modern contraception
Scholastica is lucky to be living in Nairobi and the earliest she can start using any family planning methods is when she is probably done with her secondary education at the age of 20 years; when she is joining university and getting sexually active, unlike her rural age mates who probably have given birth to one or two children and are already married.

The preferred method for the unmarried is the pills and the three months injectable.

The diseases to fight
Death in Kenya can be tied to many different factors, including a person's gender, race or ethnicity, personal habits and the region where one lives.

The survey released this month shows that male death registration increased from 104,832 in 2020 to 131,599 in 2021 while female death registration rose from 80,553 in 2020 to 100,345 in 2021. The registered male deaths accounted for 56.7 per cent of the total deaths registered in 2021 occurring in health facilities. 

Scholastica is likely to stay longer than her male age mates. 

The World Health Organization groups the causes of death into three categories: communicable (infectious and parasitic diseases and maternal, perinatal, and nutritional conditions), non-communicable (chronic), and injuries. 

More Kenyans died from non-communicable diseases. These diseases are not passed from person to person and typically progress slowly. 

Lung diseases such as pneumonia (chest infection) were the top killers,  with pneumonia responsible for two in 10 deaths last year. 

For Scholastica, she is likely to die of pneumonia, cancer, sudden death and malaria, with more males than females dying from these diseases. Additionally, I am also likely to die of anaemia, diabetes and birth asphyxia at child-bearing age.

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