Urban-rural Differentials of Neonatal Mortality in Kenya

Abstract

Child survival is a key element to measure a country‘s developmental level in addition to help track and monitor progress made in achieving the 2030 Agenda. According to the publication on the child Mortality trends and levels report by Child Mortality Estimation United Agency Group (UN-IGME) 2019, child deaths need to be dealt with urgently. In 2018, the publication indicates that neonatal mortality rates globally contributed to 47 per cent, that is, almost half of all mortalities under-5. In Kenya, neonatal mortality‘s contribution to under-five mortality has shown a steady chronological increase from 29% in the year 2003 KDHS to 44 percent in 2014 KDHS. Neonatal mortality rates in urban areas have been low compared to rural areas from 2003 and 2008/09 KDHS, however, in 2014 the urban areas recorded higher rates in comparison to rural areas. Understanding the rural-urban differentials provides a platform for policy-making and implementation of specific programs targeting predisposing factors of neonatal mortality. This study sought to identify factors (socioeconomic, demographic and healthcare seeking behavior) associated with urban-rural differentials of neonatal mortality in Kenya. The conceptual framework borrowed heavily from the Mosley and Chen theoretical framework of 1984 on child survival. Data used was drawn from the 2014 Health Survey for Populations in Kenya and data analysis was performed using SPSS where descriptive statistics, bivariate analysis (chi-square) as well multivariate regression analysis. Marital status, maternal age at 1st birth, forthcoming birth interval, gender of child, size of the child, frequency of visits for antenatal care visits, timings of antenatal care sessions, and place of delivery had statistical association with neonatal mortality in either area of residence. The association was significant at 5 per cent level. Child size at birth and frequency of antenatal visits during pregnancy were found to considerably affect neonatal mortality rates in urban areas. One of the key recommendations from the study is to formulate policies and programs that are tailored to meet specific needs from rural and urban areas in curbing neonatal deaths. Causes, effects and remedies of low birth weight should be addressed in urban areas of residence. Moreover, measures need to be strengthened or inculcated to encourage and advocate for pregnant women to attend antenatal care, in urban areas. Recommendations for further studies include a further breakdown of urban categories to include peri-urban, slum and non-slum urban areas to provide a basis for targeted intervention to minimize neonatal mortality rates in the urban residential areas.