Determinants of mortality differentials in infancy and childhood by sex in Kenya

Abstract

The mam objective of this study is to find out the determinants of mortality differentials by sex among infants and children in Kenya. The study examines sex differentials in childhood mortality by birth order and also attempts to determine the principal behavioural mechanisms responsible for mortality differentials among boys and girls. The rationale of the study is that once the determinants of mortality differentials by sex are known then preventing excess mortality among either boys or girls who are exposed to the same environmental conditions becomes easier. The study applied direct estimation methods for child mortality rates using the 1993 Kenya Demographic and Health Survey (KDHS) data. Logistic regression method was used to study the childhood mortality determinants for males and females separately. There are wide regional variations in imrnunisation by sex. Higher imrnunisation coverage was recorded among male children in Western and Rift Valley provinces while in Coast and Central provinces, more female than male children were vaccinated. Girls in Coast province and boys in Central province had higher immunisation drop out rates compared to their counterparts of opposite sex. The analysis further indicates that there were no significant differentials in the duration of breast feeding and nutritional status of boys and girls. Boys and girls are subjected to the same physical and personal environment given that there are no pronounced differentials by sex in the prevalence of fever and cough, diarrhoea and also cough with short rapid breathing. At the national level, Kenya has no significant differentials in the health care coverage given to male and female children suffering from fever and cough or cough with short rapid breathing. However, at a provincial level, compared to girls suffering from these ailments, boys in Coast province were more likely to be given health care attention. The study finds that immunisation coverage is the most significant determinant of infant and child mortality. In Coast province with higher girls relative to boys' immunisation dropout rates, there was higher female than male post neonatal mortality. In Central and Western provinces with more male than female immunisation dropout rates, boys die more than girls in the post neonatal period in Central province, and in the 12-23 age group in Western province. Regarding health care, higher male than female toddler (12-23 months) mortality in Nairobi province coincides with less frequent parental visits to health care facilities to treat boys than girls, in the event of fever and cough or cough with short rapid breathing. Higher female than male Post neonatal mortality in Coast province also coincides with higher health care coverage given to boys, relative to girls in the event of fever and cough and also cough with short rapid breathing. The study recommends an intensification of immunisation promotion programs placing greater emphasis on equal immunisation coverage for male and female children in Coast and Central province, and reduced immunisation dropout rates for subsequent doses after the first dose of DPT and polio vaccines. The study also calls for change in attitude and practice regarding health-seeking behaviour so as to increase health care coverage among children of both sexes, especially in Nyanza and Western provinces. Further research is recommended on a household level analysis of the effect of family composition on mortality differentials by sex in Kenya.