Effectiveness of antenatal care services in reducing neonatal mortality in Kenya: analysis of national survey data

ABSTRACT

Background: Although global neonatal mortality declined by about 40 percent from 1990 to 2013, it still accounted for about 2.6 million deaths globally and constituted 42 percent of global under-five deaths. Most of these deaths occur in developing countries. Antenatal care (ANC) is a globally recommended strategy used to prevent neonatal deaths. In Kenya, over 90 percent of pregnant women attend at least one ANC visit during pregnancy. However, Kenya is currently among the 10 countries that contribute the most neonatal deaths globally.

Objective: The aim of this study is to examine the effectiveness of ANC services in reducing neonatal mortality in Kenya.

Methods: We used binary logistic regression to analyse cross-sectional data from the 2014 Kenya Demographic and Health Survey to investigate the effectiveness of ANC services in reducing neonatal mortality in Kenya. We determined the population attributable neonatal mortality fraction for the lack of selected antenatal interventions.

Results: The highest odds of neonatal mortality were among neonates whose mothers did not attend any ANC visit (adjusted odds ratio [aOR] 4.0, 95% confidence interval [CI] 1.7–9.1) and whose mothers lacked skilled ANC attendance during pregnancy (aOR 3.0, 95% CI 1.4–6.1). Lack of tetanus injection relative to one tetanus injection was significantly associated with neonatal mortality (aOR 2.5, 95% CI 1.0–6.0). About 38 percent of all neonatal deaths in Kenya were attributable to lack of check-ups for pregnancy complications.

Conclusions: Lack of check-ups for pregnancy complications, unskilled ANC provision and lack of tetanus injection were associated with neonatal mortality in Kenya. Integrating community ANC outreach programmes in the national policy strategy and training geared towards early detection of complications can have positive implications for neonatal survival.

KEYWORDS:

• Antenatal care
• neonatal mortality
• tetanus toxoid
• population attributable fraction

Responsible Editor Jennifer Stewart Williams, Umeå University, Sweden

Responsible Editor Jennifer Stewart Williams, Umeå University, Sweden

Acknowledgments

Much gratitude to the Demographic and Health Survey programme for having made available the 2014 data for this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

DHS data collection and storage ensured that all participants remained anonymous and all identifiers were removed. Therefore, confidentiality was guaranteed. Data-sets are publicly accessible on request and permission to access, download and store the data-sets for this study was obtained in February 2016 from ORC Macro Inc.

Paper context

Inadequate antenatal care is a major reason for the slow decline of neonatal mortality in Kenya. The Division of Reproductive Health (DRH) is currently implementing the Vision 2030 which aims to lower the number of neonatal deaths. However, there is no comprehensive standardized system to evaluate the antenatal care interventions in terms of neonatal survival. We hope our study will provide a basis for continuous countrywide research and contribute to policy developments aimed to improve neonatal survival.

Additional information

Funding

The authors of this study have not received any funding or benefits from any industry or any other entity.

Notes on contributors

Malachi Arunda

MA conceptualised the research, drafted the design, acquired the data-set, conducted analysis, interpretation and developed the first version of the manuscript, AE and BOA involved in development of the structure, design and critical review of the manuscript. The authors read and approved the final version of the manuscript.

Anders Emmelin

MA conceptualised the research, drafted the design, acquired the data-set, conducted analysis, interpretation and developed the first version of the manuscript, AE and BOA involved in development of the structure, design and critical review of the manuscript. The authors read and approved the final version of the manuscript.

Benedict Oppong Asamoah

MA conceptualised the research, drafted the design, acquired the data-set, conducted analysis, interpretation and developed the first version of the manuscript, AE and BOA involved in development of the structure, design and critical review of the manuscript. The authors read and approved the final version of the manuscript.