Introduction:

The 2014 Kenya Demographic and Health Survey KDHS is the first survey in Kenya to produce countylevel estimates. These estimates show notable variation among counties in maternal health indicators.rnFor example Turkana has the lowest proportion of women who receive postnatal care PNC within 48rnhours of delivery 14 while Nairobi has the highest proportion 72. Within each county importantrndisparities in maternal health may exist across wealth education urban-rural residence and other sociodemographic characteristics. Understanding where these regional and socio-demographicrndisparities exist is an important first step to ensure they do not persist or widen as Kenyanrncounties work to improve maternal health indicators.

Objectives:

This study examines maternal health indicators in 10 counties designated byrnUSAID as high-priority areas for improvements in maternal healthBaringornKakamega Kilifi Kisumu Kitui Migori Nakuru Samburu Turkana andrnthe informal settlements of Nairobi

Methodology:

Using data from 3574 women in the 2014 KDHSrnwith a birth in the past five years in high-priorityrncounties this study analyzes the prevalence andrndistributional patterns of fertility risk distancernto health facilities antenatal care ANC deliveryrnin a health facility and PNC. Chi-square testsrnof independence indicate whether statisticallyrnsignificant associations exist between county orrnsocio-demographic characteristics and maternalrnhealth indicators. The study looks for regionalrndisparities and inequities by maternal age atrnbirth parity education wealth residence religionrnfertility risk and whether distance to a healthrnfacility is reported to be a big problem.

Findings:

Results:

This study shows large regional variation inrnmaternal health indicators. High-priorityrncounties other than Nairobi consistently arerndisadvantaged compared to Kenya as a whole inrnmost maternal health indicators.rn There are a higher number of inequities inrnthe distribution of delivery care and a lowerrnnumber of inequities in ANC. Inequitiesrnare also observed in fertility risk and PNC. Thernmost common disparities at the county level arernby womens education wealth and urban-ruralrnresidence. Turkana shows fewer disparities inrnmaternal health indicators compared to KilifirnKisumu and Kitui.rn Adequate ANC is defined as four or more ANCrnvisits and the first visit within the first three monthsrnof pregnancy. Significant inequities in adequaternANC use by education are found in 6 of thern10 study counties. Disparities in facility deliveryrnby residence are statistically significant in all ninerncounties where they could be measured exceptrnTurkana. Disparities in PNC within 48 hours ofrndelivery by wealth tercile are found in just fourrncounties but are quite sizable where they exist.

Conclusion:

County-specific data are necessary as the first steprnfor Kenya to achieve equitable provision of healthrncare as promoted in the Kenya Health Policy 2012-rn2030 and Sustainable Development Goals. This studyrnreveals substantial and significant regional variation inrnall maternal health indicators across counties.rn The comparison of high-priority counties withrnnational figures suggests that USAID is appropriatelyrnfocusing its efforts on areas most in need of betterrnmaternal health care.

Author(s):

Focus County(s):

National

Programme Area(s):

Sexual, Reproductive, Adolescent & Child Health

Research Priority Area(s):

Disease Domain(s):

maternal Health

Publication Date: 16.Jun.2014

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