Saturday, August 25, 2007

Poverty still driving high child deaths in Africa

from Africa Science News

Written by Leakey Sonkoyo

Even after the Kenya government waived fees for ante-natal and post-natal care, records still show that many expectant mothers are delivering their babies at home under the care of traditional midwives and sometimes inexperienced and untrained birth attendants.

In Kenya as in most of the developing countries, maternal and infant mortality rates are still very high compared to the developed countries.

While infant mortality rate in Kenya stood at 77 deaths in every 1000 live births in 2003, less than 4 mortalities in every 1000 live births was recorded in Finland, the country with the lowest infant mortality rates in the world.

A myriad of factors account for such high numbers of infant deaths in Kenya chief among them being poverty.

In a country where more than 50 percent of 34 million people live on less than a dollar a day, it comes as no surprise that most of the people cannot afford basic health care.

The problem has been reinforced by the fact that most public health facilities are very far so that the mere cost of reaching a maternity hospital is considered substantial.

Globally, as of 1999, the infant mortality rate was about 80 infants per 1,000. In developed countries, the rate was below 10 per 1,000 while in developing countries it neared 200 per 1,000.

This is generally due to greater access to advanced medical technology, adequate sanitation, contraception, good nutrition for prenatal and postnatal care, and educational and informational awareness programs in developed nations.

The Kenyan Government endorsed the Millennium Declaration at the Millennium Summit in September 2000.

The declaration set Millennium Development Goals (MDG's) which are sets of quantified and time bound achievable goals, agreed on by all UN member states in 2000, for dramatically improving the human conditions by 2015.

MDG's set internationally accepted targets for the reduction of income and non income poverty and are expected to form the core of national poverty reduction planning processes. The MDG's comprise 8 goals, 18 targets and 48 indicators.

Target number four of the MDG’s is to reduce by two thirds the mortality rates for children under five and with less than seven years to go, there is still a lot left to be done.

Records at the ministry of health indicate that infant mortality rates have actually increased from 63 deaths per 1000 children in 1990 to 77 deaths per 1000 children in 2003.

According to the Kenya Demographic and Health Survey (KDHS) of 1998, there was a wide disparity of under five mortality with Central, Nairobi, Rift Valley and Eastern provinces recording lower mortality rates while the poorer Coast, Western and Nyanza provinces recorded higher mortality rates.

Nyanza recorded the highest number of deaths with over 198 mortalities while Central province recorded the lowest with just under 34 deaths per 1000 live births against the MDGs target of not more than 32 deaths per 1000 live births.

Education and awareness is also another major factor that has contributed to the surge in infant mortality. Immunization against the most common diseases like measles has gone down in an ironical trend considering that people are getting more enlightened and not the vice versa.

According to the WHO/UNICEF Review of National Immunization Coverage 1980-1999, the reported coverage levels using administrative data were high in the eighties and early nineties.

The KDHS surveys of 1993 estimated measles vaccine coverage to be at 84%. However, the same surveys in 1998 and in 2000 indicated a decline in measles vaccine coverage of 79% and 76%, respectively.

Measles vaccine coverage is particularly low in Western and Nyanza provinces with 58% and 68% in 2000 respectively, again emphasizing the effects of poverty.

On the mothers front, it is estimated that there are 590 maternal deaths per 100 000 live births. This is 1998 KDHS data that also indicates that there is a high burden of unsafe motherhood in Kenya again with huge disparities among the different regions.

The maternal deaths seem to have subsided to 414 in 2003 but still very high as compared to the MDGs’ and indeed the government’s target of 91 deaths per 100 000 live births.

The determinants of maternal mortality and morbidity in Kenya are many including; hemorrhage, sepsis, complications of unsafe and induced abortion, eclampsia and obstructed labor. Some of these are due to inadequate and poor quality of ante natal care services and Post natal care services in many parts of the country.

There is also need to increase the proportion of births attended by skilled health workers from the current 40 percent.

Alleviation of poverty will in effect improve the health status of women and children by stemming malnutrition, ignorance and other problems that belabour the majority of the population health wise.

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