Volume 85, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We report and explore changes in child mortality in a rural area of Kenya during 2003–2009, when major public health interventions were scaled-up. Mortality ratios and rates were calculated by using the Kenya Medical Research Institute/Centers for Disease Control and Prevention Demographic Surveillance System. Inpatient and outpatient morbidity and mortality, and verbal autopsy data were analyzed. Mortality ratios for children less than five years of age decreased from 241 to 137 deaths/1,000 live-births in 2003 and 2007 respectively. In 2008, they increased to 212 deaths/1,000 live-births. Mortality remained elevated during the first 8 months of 2009 compared with 2006 and 2007. Malaria and/or anemia accounted for the greatest increases in child mortality. Stock-outs of essential antimalarial drugs during a time of increased malaria transmission and disruption of services during civil unrest may have contributed to increased mortality in 2008–2009. To maintain gains in child survival, implementation of good policies and effective interventions must be complemented by reliable supply and access to clinical services and essential drugs.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. United Nations, 2009. The Millenium Development Goals Report, 2009. New York: United Nations. [Google Scholar]
  2. Laserson KF, Odhiambo F, Hamel MJ, Feikin DR, Bayoh N, Nyaguara AO, Sewe M, Ogwang S, Obor D, , 2009. KEMRI/CDC Health and Demographic Surveillance System, Kisumu, Kenya, Fifth Annual Report, Sixth Year of Registration of Demographic Events, 2007. Kisumu: KEMRI/CDC. [Google Scholar]
  3. Phillips-Howard PA, Nahlen BL, Alaii JA, ter Kuile FO, Gimnig JE, Terlouw DJ, Kachur SP, Hightower AW, Lal AA, Schoute E, Oloo AJ, Hawley WA, , 2003. The efficacy of permethrin-treated bed nets on child mortality and morbidity in western Kenya I. Development of infrastructure and description of study site. Am J Trop Med Hyg 68: 39. [Google Scholar]
  4. Adazu K, Lindblade KA, Rosen DH, Odhiambo F, Ofware P, Kwach J, Van Eijk AM, Decock KM, Amornkul P, Karanja D, Vulule JM, Slutsker L, , 2005. Health and demographic surveillance in rural western Kenya: a platform for evaluating interventions to reduce morbidity and mortality from infectious diseases. Am J Trop Med Hyg 73: 11511158. [Google Scholar]
  5. Kenya National Bureau of Statistics (KNBS) and ICF Macro, 2010. Kenya Demographic and Health Survey 2008–09. Calverton, MD: KNBS and ICF Macro. [Google Scholar]
  6. Amornkul PN, Vandenhoudt H, Nasokho P, Odhiambo F, Mwaengo D, Hightower A, Buve A, Misore A, Vulule J, Vitek C, Glynn J, Greenberg A, Slutsker L, De Cock KM, , 2009. HIV prevalence and associated risk factors among individuals aged 13–34 years in rural western Kenya. PLoS ONE 4: e6470.[Crossref] [Google Scholar]
  7. Anker M, Black RE, Coldham C, Kalter HD, Quigley MA, Ross D, Snow RW, , 1999. A Standard Verbal Autopsy Method for Investigating Causes of Death in Infants and Children. WHO/CDS/CSR/ISR/99.4. Geneva: World Health Organization, Baltimore: Department of Communicable Disease Surveillance and Response: The Johns Hopkins School of Hygiene and Public Health, and London: London School of Hygiene and Tropical Medicine. [Google Scholar]
  8. McElroy PD, Terk Kuile FO, Hightower AW, Hawley WA, Phillips-Howard PA, Oloo AJ, Lal AA, Nahlen BL, , 2001. All-cause mortality among young children in western Kenya. VI: The Asembo Bay Cohort Project. Am J Trop Med Hyg 64: 1827. [Google Scholar]
  9. Brabin BJ, Premji Z, Verhoeff F, , 2001. An analysis of anemia and child mortality. J Nutr 131: 636S645S, discussion 646S–648S. [Google Scholar]
  10. Akhwale WS, Lum JK, Kaneko A, Eto H, Obonyo C, Bjorkman A, Kobayakawa T, , 2004. Anemia and malaria at different altitudes in the western highlands of Kenya. Acta Trop 91: 167175.[Crossref] [Google Scholar]
  11. Filmer D, Pritchett LH, , 2001. Estimating wealth effects without expenditure data–or tears: an application to educational enrollments in states of India. Demography 38: 115132. [Google Scholar]
  12. Lindblade KA, Mwololo K, van Eijk AM, Peterson E, Odhiambo F, Williamson J, Slutsker L, , 2006. Evaluation of the WHO Haemoglobin Colour Scale for diagnosis of anaemia in children and pregnant women as used by primary health care nurses and community health workers in western Kenya. Trop Med Int Health 11: 16791687.[Crossref] [Google Scholar]
  13. Kenya National Council for Population and Development, Central Bureau of Statistics, 1994. Macro International Demographic and Health Survey of Kenya in 1993. Afr J Med Pract 1: 4148. [Google Scholar]
  14. Guay LA, Musoke P, Fleming T, Bagenda D, Allen M, Nakabiito C, Sherman J, Bakaki P, Ducar C, Deseyve M, Emel L, Mirochnick M, Fowler MG, Mofenson L, Miotti P, Dransfield K, Bray D, Mmiro F, Jackson JB, , 1999. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 354: 795802.[Crossref] [Google Scholar]
  15. Dabis F, Msellati P, Meda N, Welffens-Ekra C, You B, Manigart O, Leroy V, Simonon A, Cartoux M, Combe P, Ouangre A, Ramon R, Ky-Zerbo O, Montcho C, Salamon R, Rouzioux C, Van de Perre P, Mandelbrot L, , 1999. 6-month efficacy, tolerance, and acceptability of a short regimen of oral zidovudine to reduce vertical transmission of HIV in breastfed children in Côte d'Ivoire and Burkina Faso: a double-blind placebo-controlled multicentre trial. DITRAME Study Group. Diminution de la transmission mere-enfant. Lancet 353: 786792.[Crossref] [Google Scholar]
  16. Preble EA, , 1990. Impact of HIV/AIDS on African children. Soc Sci Med 31: 671680.[Crossref] [Google Scholar]
  17. Republic of Kenya Ministry of Health, 2006. National Guidelines for Diagnosis, Treatment and Prevention of Malaria. Nairobi, Kenya: Ministry of Health, Division of Malaria Control. [Google Scholar]
  18. Straus WL, Qazi SA, Kundi Z, Nomani NK, Schwartz B, , 1998. Antimicrobial resistance and clinical effectiveness of co-trimoxazole versus amoxicillin for pneumonia among children in Pakistan: randomised controlled trial. Pakistan Co-trimoxazole Study Group. Lancet 352: 270274.[Crossref] [Google Scholar]
  19. Abdulla S, Oberholzer R, Juma O, Kubhoja S, Machera F, Membi C, Omari S, Urassa A, Mshinda H, Jumanne A, Salim N, Shomari M, Aebi T, Schellenberg DM, Carter T, Villafana T, Demoitié MA, Dubois MC, Leach A, Lievens M, Vekemans J, Cohen J, Ballou WR, Tanner M, , 2008. Safety and immunogenicity of RTS,S/AS02D malaria vaccine in infants. N Engl J Med 359: 25332544.[Crossref] [Google Scholar]
  20. Dowell SF, Davis HL, Holt EA, Ruff AJ, Kissinger PJ, Bijoux J, Boulos R, Boulos C, Halsey NA, , 1993. The utility of verbal autopsies for identifying HIV-1-related deaths in Haitian children. AIDS 7: 12551259.[Crossref] [Google Scholar]
  21. Ouma PO, van Eijk AM, Hamel MJ, Sikuku ES, Odhiambo FO, Munguti KM, Ayisi JG, Crawford SB, Kager PA, Slutsker L, , 2010. Antenatal and delivery care in rural western Kenya: the effect of training health care workers to provide “focused antenatal care”. Reprod Health 7: 1.[Crossref] [Google Scholar]
  22. Kaai S, Baek C, Geibel S, McOdida P, Benson U, Muthumbi G, N'Katha-Matiko C, , 2005. HIV Serostatus and Infant Feeding Counseling and Practice: Findings from a Baseline Study among the Urban Poor in Kenya. Washington, DC: Population Council, 6. [Google Scholar]
  23. Brahmbhatt H, Kigozi G, Wabwire-Mangen F, Serwadda D, Lutalo T, Nalugoda F, Sewankambo N, Kiduggavu M, Wawer M, Gray R, , 2006. Mortality in HIV-infected and uninfected children of HIV-infected and uninfected mothers in rural Uganda. J Acquir Immune Defic Syndr 41: 504508.[Crossref] [Google Scholar]
  24. Obonyo CO, Ochieng F, Taylor WR, Ochola SA, Mugitu K, Olliaro P, ter Kuile F, Oloo AJ, , 2003. Artesunate plus sulfadoxine-pyrimethamine for uncomplicated malaria in Kenyan children: a randomized, double-blind, placebo-controlled trial. Trans R Soc Trop Med Hyg 97: 585591.[Crossref] [Google Scholar]
  25. Tren R, Hess K, Bate R, , 2009. Drug procurement, the Global Fund and misguided competition policies. Malar J 8: 305.[Crossref] [Google Scholar]
  26. Kangwana BB, Njogu J, Wasunna B, Kedenge SV, Memusi DN, Goodman CA, Zurovac D, Snow RW, , 2009. Malaria drug shortages in Kenya: a major failure to provide access to effective treatment. Am J Trop Med Hyg 80: 737738. [Google Scholar]
  27. Snow RW, Trape JF, Marsh K, , 2001. The past, present and future of childhood malaria mortality in Africa. Trends Parasitol 17: 593597.[Crossref] [Google Scholar]
  28. Sacarlal J, Nhacolo AQ, Sigauque B, Nhalungo DA, Abacassamo F, Sacoor CN, Aide P, Machevo S, Nhampossa T, Macete EV, Bassat Q, David C, Bardaji A, Letang E, Saute F, Aponte JJ, Thompson R, Alonso PL, , 2009. A 10 year study of the cause of death in children under 15 years in Manhica, Mozambique. BMC Public Health 9: 67.[Crossref] [Google Scholar]
  29. Malaria. Snow RW, Omumbo JA, Jamison DT, Feachem RG, Makgoba MW, Bos ER, Baingana FK, Hofman KJ, Rogo KO, , 2006. In: , eds. Disease and mortality in sub-Saharan Africa. 2nd edition. Washington, DC: World Bank. Chapter 14. [Google Scholar]
  30. English M, Punt J, Mwangi I, McHugh K, Marsh K, , 1996. Clinical overlap between malaria and severe pneumonia in African children in hospital. Trans R Soc Trop Med Hyg 90: 658666.[Crossref] [Google Scholar]
  31. Snow RW, Armstrong JR, Forster D, Winstanley MT, Marsh VM, Newton CR, Waruiru C, Mwangi I, Winstanley PA, Marsh K, , 1992. Childhood deaths in Africa: uses and limitations of verbal autopsies. Lancet 340: 351355.[Crossref] [Google Scholar]
  32. Feikin DR, Adazu K, Obor D, Ogwang S, Vulule J, Hamel MJ, Laserson K, , 2010. Mortality and health among internally displaced persons in western Kenya following post-election violence, 2008: novel use of demographic surveillance. Bull World Health Organ 88: 601608 [Crossref] [Google Scholar]
  33. SAVVY, Sample Vital Registration with Verbal Autopsy: Verbal Autopsy Certifier and Coder's Manual. August 2007. Available at: http://www.cpc.unc.edu/measure/publications/ms-07-26-vac. [Google Scholar]

Data & Media loading...

  • Received : 29 Nov 2010
  • Accepted : 17 Jun 2011
  • Published online : 01 Oct 2011

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error