The Determinants of Maternal Mortality in Kenya: a Spatio-temporal Analysis

Abstract

Maternal mortality remains a critical global health issue, with an estimated 800 women dying daily from pregnancy-related complications. In Kenya, despite policies aimed at reducing maternal deaths and achieving the Sustainable Development Goals target of 70 per 100,000 live births by 2030, the 2020 World Health Organization estimates reveal a maternal mortality rate (MMR) of 530 per 100,000 live births over seven times the target. This study investigates the spatial-temporal factors associated with maternal mortality in Kenya, assesses the impact of maternal service accessibility, and evaluates the influence of government initiatives. Data from the Kenya Health Information System (KHIS) and the 2022 Kenya Demographic and Health Survey (KDHS) for 2019 to 2024 were analysed. MMR estimates were 284 in 2019, 385 in 2021, and 345 in 2022. An increase in the proportion of uneducated mothers, smoking mothers, those living within 2 hours of a health facility, and those with multiple gestations is linked to higher maternal mortality risks, with factors of 3.86 (95% CI: 2.39, 6.17), 5.47 (95% CI: 3.49, 8.57), 9.03 (95% CI: 6.49, 12.68), and 9.58 (95% CI: 7.32, 12.43). In contrast, higher contraceptive prevalence, Caesarean section rates, and fourth antenatal visits provide protection, with IRRs of 0.24 (95% CI: 0.17, 0.34), 0.002 (95% CI: 0.0015, 0.004), and 0.09 (95% CI: 0.068, 0.12). The Poisson mixed-effects model showed that travel times exceeding two hours significantly increased maternal mortality risk, with an incidence rate ratio (IRR) of 6.1516 (95% CI: [5.6353, 6.6679], p < 1.27e-120), emphasizing the severe impact of prolonged travel. The interrupted time series analysis indicated an increase in the MMR following a financial instability in the Linda Mama program, but this increase was not statistically significant (0.7363, t = 1.249), suggesting that the intervention’s immediate effect may not be clear, warranting further investigation into its long-term impact.