Pneumonia the top killer as Rift Valley records more deaths in 2020

More people died last year in the Rift Valley, with the region recording the highest number of deaths at 40,126, according to the data from the Civil Registration Services (CRS) under the Ministry of Interior.

Eastern came second with 28,722 registered deaths, followed by Central 27,585, Nyanza 26,191, Western 23,094, Nairobi 21,667, Coast 16,036 and North Eastern recorded the least deaths at 1,274.

The data from CRS, dubbed Kenya Vital Statistics Report 2020, revealed that nationally, the rate of registration of deaths stood at just 37 per cent with 185,385 recorded, down from 191,495 in 2019.

Overall, the report depicts a declining trend in death registrations from a high of 41.9 per cent in 2016 to 37 per cent in 2020.

The decline in 2020 has been partly attributed to the negative impacts of the Covid-19 pandemic, which slowed down transmission of records, and shortened the burial time thus there is a possibility that notification of the event may have been missed or documentation not done.

Generally, the low registration rates are attributed to among other factors, cultural and religious beliefs, geographical coverage especially due to poor terrain and vast sub-locations, nomadism and informal settlements, weak legislation and non-enforcement of the law on registration, non-existence of service delivery points in most sub-counties, and existence of late registration, which encourages people not to notify events within the stipulated period.

Death registration

The national decline in death registration is reflected in the regions, which also depicted a similar trend in the rate of registering deaths. Regions with the highest decline are Western (44.6 per cent to 39.5 per cent) and North Eastern (six per cent to four per cent).

For the data, only two counties (Nairobi 63 per cent and Embu 62 per cent) had more than 60 per cent coverage. Fifteen counties recorded higher death registrations over the national average of 37 per cent while 32 counties recorded registration rates below the national average.

This is even as seven out of 10 deaths registered in Nairobi occurred at home, (73 per cent)with only 27 per cent being recorded in health facilities.

Rift Valley came second with 62 per cent home deaths, Coast 53 per cent and Eastern 52 per cent. Only Western, Central, Nyanza and North Eastern had more cases recorded in facilities than at home.

Nationally, the percentage of registered deaths in health facilities declined from 57.2 per cent to 53.6 per cent compared to deaths registered in the community, which increased from 43 per cent to 47 per cent in 2020.

Place of occurrence refers to either the health facility or community where the death occurred. The tabulation of deaths registered by place of occurrence allows ascertainment of the number of deaths that occur in all health facilities compared with those that occur in the community.

Ms Jane Mucheru, the director of civil registration and vital statistics, said that registration of deaths remain low as more deaths happen at home.

Rapid Mortality Surveillance

“In order to improve the reporting, we have partnered with the World Health Organisation to launch a Rapid Mortality Surveillance (RMS) project for real-time data. We are piloting in Nairobi, Kajiado, Siaya, Busia, Machakos and Mombasa. We are the primary generators of data and other agencies depend on us,” she said.

Counties with highest proportions of registered community deaths included Wajir (97 per cent), Mandera (90 per cent), Vihiga (80 per cent) and Marsabit (67 per cent) while those with the lowest proportions of registered community deaths were Samburu (23 per cent), Uasin Gishu (24 per cent), Bomet (26 per cent), and West Pokot (27 per cent).

Notably, most counties at the border points reported coverages of below 30 per cent.

Similarly, most counties presented a decline in death registration except for Tharaka Nithi (13 per cent), Kirinyaga (6.3 per cent), West Pokot (5.2 per cent), Kitui (4.7 per cent), Nyamira (4 per cent), Nyeri (3.7 per cent) and Nakuru (1.7 per cent).

On the other hand, counties that recorded the highest percentage decline in death registration were Machakos (20.8 per cent), Busia (6.2 per cent) Uasin Gishu (5.4 per cent), Trans Nzoia (4.8 per cent) and Kakamega (4.3 per cent).

During the period under review, more males were registered having died compared to females nationally. There was a decrease in registered female deaths from 85,701 in 2019 to 80,553 in 2020, the coverage declined by 2.1 per cent from 39.1 per cent in 2019 to 37 per cent in 2020.

Most counties reported a higher death registration of males than females.

“Higher death registration for males may be attributed to the fact that they are more likely to own property compared to women and therefore accruing benefit in registering deaths of deceased males. This can also be attributed to the fact that more males are being born than females,” says the study.

Pneumonia remained the leading cause of deaths nationally in the past five years, accounting for 11.2 per cent of all deaths in 2020. Cancer continues to be the second killer disease nationally across the years and at 8.3 per cent in 2020.

Sudden death stands at third position with seven per cent of all deaths in 2020, malaria (six per cent), cardiac arrest (5.4 per cent), hypertension (5.1 per cent), and respiratory infection (3.4 per cent) with tuberculosis, anaemia and diabetes accounting for 3.1 per cent of all the deaths in 2020.

HIV/Aids was among the top 10 causes of deaths between 2015 and 2018, but dropped in the last two years.

Road traffic accidents were conspicuously missing from the top 10 causes of death in 2020 but were among the top leading causes in the last five years.

Overall, the leading killer diseases for both males and females in health facilities were cardiorespiratory failures (9.3 per cent), pneumonia (9.1 per cent), cancer (6.1 per cent), respiratory infections (5.8 per cent), and hypertension (5.5 per cent).

However, the main killer diseases in the community in 2020 were sudden death (14 per cent), pneumonia (14 pe rcent), cancer (11 per cent), malaria (10 per cent) and hypertension (4.7 per cent).

Tuberculosis (4.1 per cent), asthma (3.3 per cent), diabetes (3.1 per cent), anaemia (2.5 per cent) and kidney and urinary tract infections (2.5 per cent) were other major causes of death at home.

Notably, more deaths occurred as a result of pneumonia and cancer at home than in health facilities.

The main causes for neonatal, infant and under-five mortality were prematurity and birth asphyxia, respiratory infections and pneumonia while deaths in children aged 5-14 were mainly caused by malaria, pneumonia and anaemia.

Mortality in females of reproductive age and men aged (15-49) was mainly caused by pneumonia, cancer, sudden death, cardio-respiratory failure and tuberculosis while cancer and pneumonia were the two main leading causes of death for the population age 50-59 and over 60 years followed by sudden death and diseases associated with the heart.