Health in Kenya

This article is about Health in Kenya. For the health care system see Healthcare in Kenya

Tropical diseases, especially malaria and tuberculosis, have long been a public health problem in Kenya. In recent years, infection with the human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS), also has become a severe problem. Estimates of the incidence of infection differ widely.

Health status

HIV/AIDS

The United Nations Development Program (UNDP) claimed in 2006 that more than 16 percent of adults in Kenya are HIV-infected.^[1] The Joint United Nations Programme on HIV/AIDS (UNAIDS) cites the much lower figure of 6.7 percent.^[1]

Despite politically charged disputes over the numbers, however, the Kenyan government recently declared HIV/AIDS a national disaster. In 2004 the Kenyan Ministry of Health announced that HIV/AIDS had surpassed malaria and tuberculosis as the leading disease killer in the country. Due largely to AIDS, life expectancy in Kenya has dropped by about a decade. Since 1984 more than 1.5 million Kenyans have died because of HIV/AIDS.^[1]

More than 3 million Kenyans are HIV positive. More than 700 people a day die of HIV-related illnesses. The prevalence rate for women is nearly twice that for men. The rate of orphanhood stands at about 11 percent.^[1]

AIDS has contributed significantly to Kenya's dismal ranking in the latest UNDP Human Development Report, whose Human Development Index (HDI) score is an amalgam of gross domestic product per head, figures for life expectancy, adult literacy, and school enrolment. The 2006 report ranked Kenya 152nd out of 177 countries on the HDI and pointed out that Kenya is one of the world's worst performers in infant mortality. Estimates of the infant mortality rate range from 57 to 74 deaths/1,000 live births. The maternal mortality ratio is also among the highest in the world, due in part to female genital mutilation. The practice has been fully prohibited nationwide since 2011.^[2]

Car accidents

Apart from major disease killers, Kenya has a serious problem with accidental death, specifically by motor vehicles. Kenya has the highest rate of road accidents in the world, with 510 fatal accidents per 100,000 vehicles (2004 estimate), as compared to second-ranked South Africa, with 260 fatalities, and the United Kingdom, with 20. In February 2004, in an attempt to improve Kenya's appalling record, the government obliged the owners of the country's 25,000 matatus (minibuses), the backbone of public transportation, to install new safety equipment on their vehicles. Government spending on road projects is also planned.^[1]

Maternal and Child Health Care

Maternal mortality is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”.^[3] Over 500,000 women globally die every year due to maternal causes, and half of all global maternal deaths occur in sub-Saharan Africa.^[4][5]

The 2010 maternal mortality rate per 100,000 births for Kenya is 530, yet has been shown to be as high as 1000 in the North Eastern Province, for example.^[6] This is compared with 413.4 in 2008 and 452.3 in 1990. The under 5 mortality rate, per 1,000 births is 86 and the neonatal mortality as a percentage of under 5's mortality is 33. The aim of this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Kenya the number of midwives per 1,000 live births is unavailable and the lifetime risk of death for pregnant women 1 in 38. ^[7]

Women under 24 years of age are especially vulnerable because the risk of developing complications during pregnancy and childbirth. The burden of maternal mortality extends far beyond the physical and mental health implications. In 1997, the Gross Domestic Product (GDP) loss attributable to MMR per 100,000 live births was $234 US, one of the highest losses compared to other African regions. Additionally, with the annual number of maternal deaths being 6222, the total annual economic loss due to maternal mortality in Kenya was $2240 US, again one of the highest losses compared to other African regions.^[8]

Kenya’s health infrastructure suffers from urban-rural and regional imbalances, lack of investment, and a personnel shortage, with, for example, one doctor for 10,150 people (as of 2000).^[1]

Determinants of maternal mortality and morbidity

The determinants influencing maternal mortality and morbidity can be categorised under three domains: proximate, intermediate, and contextual.^[9][10]

Proximate determinants: these refer to those factors that are mostly closely linked to maternal mortality. More specifically, these include pregnancy itself and the development of pregnancy and birth-related or postpartum complications, as well as their management. Based on verbal autopsy reports from women in Nairobi slums, it was noted that most maternal deaths are directly attributed to complications such as haemorrhage, sepsis, eclampsia, or unsafe abortions. Conversely, indirect causes of mortality were noted to be malaria, anaemia, or TB/HIV/AIDS, among others.^[11]

Intermediate determinants: these include those determinants related to the access to quality care services, particularly barriers to care such as: health system barriers (e.g. health infrastructure), financial barriers, and information barriers. For example, interview data of women aged 12–54 from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), found that the high cost of formal delivery services in hospitals, as well as the cost transportation to the these facilities presented formidable barriers to accessing obstetric care.^[12] Other intermediate determinants include reproductive health behaviour, such as receiving antenatal care––a strong predictor of later use of formal, skilled care––, and women’s health and nutritional status.

Contextual determinants: these refer primarily to the influence of political commitment––policy formulation, for example––, infrastructure, and women’s socioeconomic status, including education, income, and autonomy. With regards to political will, a highly contested issue is the legalisation of abortion. The current restrictions on abortions has led to many women receiving the procedure illegally and often via untrained staff. These operations have been estimated to contribute to over 30% of maternal mortalities in Kenya.^[13]

Infrastructure refers not only to the unavailability of services in some areas, but also the inaccessibility issues that many women face. In reference to maternal education, women with greater education are more likely to have and receive knowledge about the benefits of skilled care and preventative action—antenatal care use, for example. In addition, these women are also more likely to have access to financial resources and health insurance, as well as being in a better position to discuss the use of household income. This increased decision-making power is matched with a more egalitarian relationship with their husband and an increased sense of self-worth and self-confidence. Income is another strong predictor influencing skilled care use, in particular, the ability to pay for delivery at modern facilities.^[14]

Women living in households unable to pay for the costs of transportation, medications, and provider fees were significantly less likely to pursue delivery services at skilled facilities. The impact of income level also influences other sociocultural determinants. For instance, low-income communities are more likely to hold traditional views about birthing, opting away from skilled care use. Similarly, they are also more likely to give women less autonomy in making household and healthcare-related decisions. Thus, these women are not only unable to receive money for care from husbands––who often place greater emphasis on the purchase of food and other items––but are also much less able to demand formal care.^[14]

Maternal Health in the North-Eastern Province

The North-Eastern Province of Kenya extends over 126, 903 km2 and contains the main districts of Garissa, Ijara, Wajir, and Mandera.^[15] This area contains over 21 primary hospitals, 114 dispensaries serving as primary referrals sites, 8 nursing homes with maternity services, 9 health centres, and out of the 45 medical clinics spanning this area, 11 of these clinics specifically have nursing and midwifery services available for mothers^[16] However, health disparities exist within these regions, especially among the rural districts of the North-Eastern province. Approximately 80% of the population of the North-Eastern Province of Kenya consists of Somali nomadic pastoralist communities who frequently resettle around these regions. These communities are the most impoverished and marginalised in the region.^[17]

Despite the availability of these resources, these services are severely underused in this population. For example, despite the high MMR, many of the women are hesitant to seek delivery assistance under the care of trained birth attendants at these facilities. Instead, many of these women opt to deliver at home, which accounts for the greatest mortality rates in these regions. For example, the Ministry of Health projected that about 500 mothers would use the Garissa Provincial General Hospital by 2012 since it opened in 2007; however, only 60 deliveries occurred at this hospital. Reasons for low attendance include a lack of awareness of these facility's presence, ignorance, and inaccessibility of these services in terms of distance and costs. However, to address some of the accessibility barriers to obtaining care, there are concerted efforts within the community already such as mobile health clinics and waived user fees.^[18]

See also

• Healthcare in Kenya

References

External links

• The State of the World's Midwifery – Kenya Country Profile

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