Children born in Central Kenya are more likely to celebrate their fifth
birthday than those born in Nyanza or Western, thanks to better
healthcare coverage and a more favourable climate. PHOTO | FILE| NATION
MEDIA GROUP
At Bondo District Hospital in Siaya County, Susan Amondi is
rocking the older of her two children, one-and-a half year-old Onyango
while his five-month-old brother, chuckles as he clings to her.
The
nurse in charge tells DN2 that Onyango is suffering from malnutrition —
and a host of other infections — and that their mother had to come with
both of them when he was admitted because there was no one to look
after the younger child.
Meanwhile,
miles away at the Kiambu District Hospital in Kiambu County,
eight-month-old Mary is also admitted and being looked after by her
mother. She is suffering from a blood infection (sepsis).
A
brief chat with the two women clearly indicates that they do not
understand the ailments afflicting their children. And they are
equally unaware of the bleak — or bright — future their geographical
locations mean for their children’s survival.
While
Susan is optimistic that her son will survive the sickness that has
kept them in this hospital for more than three weeks, recent statistics
show little Mary in Kiambu is more likely to live to see her fifth
birthday than Onyango.
According
to the Demographic Survey 2014, which was launched this year, certain
regions in the country ensure better child survival than others, going
by the diseases that claim children’s lives, as well as the medical
seeking behaviour by parents of guardians, which also determine the
survival of children.
Nyanza,
Nairobi and Western are the least favourable regions for a child to grow
up in while Central and North-Eastern are the best.
For instance, for every 1,000 live births in Nyanza, 82 will die, compared with only 42 in Central.
Nairobi comes second, with 72 deaths out of every 1,000 live births, followed by Western with 64 per cent.
These data mars the country’s otherwise good record.
According
to a United Nations Children’s Fund (Unicef) report in 2014, Kenya had
managed to significantly reduce mortality in children below the age of
five.
For instance, in 2003, there were 115 deaths per 1,000 live births, but this number had been reduced to 52 by 2014.
The
report attributed this reduction to improved medical care seeking
behaviour, as well as using maternal healthcare services and delivering
in proper health facilities.
It is
worth noting that the deliveries in public health hospitals almost
trebled after the President Uhuru Kenyatta announced in June 2013 that
maternity services would be free at these facilities.
Knowledge
and proper medical seeking behaviour of mothers on infectious diseases
such as pneumonia and diarrhoea also contributed positively to the
reduction in child mortality.
Yet
the latest demographic survey highlights regional discrepancies that
stand in stark contrast the impressive general indicators.
Nyanza
and Western scored poorest in managing the diseases that claim
children’s lives, namely malaria, acute respiratory infections and
diarrhoeal diseases.
Severe
diarrhoea, which causes dehydration, has been implicated in many studies
by the World Health Organisation (WHO) as a major cause of sickness and
mortality among young children.
Figures
from Migori County indicated that 27.9 per cent of children in the area
— the highest in the country — had suffered from diarrhoea.
This
statistic is alarming as it is not only high, but also a pointer that
the number of children who had stool with traces of blood, an indicator
of the life-threatening strains of bacterial diarrhoea, were high.
Vihiga
County recorded the second highest number of children who had suffered
from diarrhoea with 23.6 per cent, followed closely by Homa Bay with
23.5 per cent.
Mandera, County recorded the fewest cases of diarrhoea, with 5 per cent, while Nyamira and Nyeri recorded 3 per cent each.
The
Homa Bay County Executive for Health, Dr Lawrence Oteny, told DN2 that
cases of water-borne diseases have remained “stubbornly” high because
the latrine and toilet coverage in the area was still low, with seven
for every 10 homes.
He added that poverty was a contributing factor to the poor toilet coverage.
“The
soil in these areas is not stable, therefore digging latrines in
homesteads is a challenge when the families are poor and cannot afford
to pay for the construction,” he said.
Indeed,
the demographic survey reported that: “Diarrhoea is less common among
children who used improved, private toilet facilities (11 per cent) than
among those who use non-improved or shared improved facilities (16 per
cent)”
FEVER
Another childhood disease listed was fever, which is a sign of either malaria or other life-threatening infections.
The
survey reported that Nyanza recorded the highest cases of fever in
children, with 37 per cent, closely followed by Western with 36 per
cent.
Pneumonia, an acute
respiratory infection (ARI), and one of whose symptoms is also fever,
remains the country’s leading killer of children under five.
Nyanza
and Western reported the highest cases of children who had suffered
from ARIs, standing at 9.7 per cent and 12.8 per cent respectively.
The
counties with the highest percentages of children with symptoms of ARI
were Vihiga (17 per cent), Bungoma (16 per cent), Baringo (14 per cent)
Homa Bay and Migori (13 per cent).
Mandera
recorded the lowest levels of ARIs with 2 per cent while Turkana,
Garissa, Kisumu, Kirinyaga, and Nyamira, registered three 3 per cent
each.
Notably, the counties with
the highest cases of ARIs used firewood and charcoal as a primary source
of energy for domestic use. Interestingly, studies have implicated the
use of firewood in the relationship between indoor pollution and
respiratory illnesses.
Vaccination
Remarkably,
despite the discouraging statistics from Nyanza and Western the two
regions performed quite well in public health interventions such as
vaccinations.
According to WHO
guidelines, a child is considered to have received all the basic
vaccinations after being inoculated against the following diseases:
tuberculosis, which is also known as BCG; three doses each of the
DPT-HepB-Hib, which prevents diphtheria; whooping cough (pertussis);
tetanus, also referred to as pentavalent; polio; and measles.
The vaccination coverage in Nyanza stood at 77 per cent while in Western, it was 81.
North Eastern performed the worst in this regard, with 55 per cent of the children there having been vaccinated.
Central
maintained the lead, with 90.3 per cent of the children having access
to all the vaccines. In fact, 97 per cent of the children in Kiambu
County had received all the necessary vaccinations.
Of
all the counties that make up Nyanza— Migori, Homa Bay, Siaya, Kisumu,
Kisii and Nyamira— Homa Bay and Migori County had the worst indicators
in the region, scoring the lowest on vaccination coverage, but the
highest in Diarrhoeal diseases, ARIs and fever.
WHY THE DIFFERENCES?
Several
explanations, both expert and layman, have been advanced to explain why
the different regions record such widely differing figures.
On that is often cited is climate.
While
the public health departments in the regions doing poorly can be blamed
in part for not containing pandemics, Nyanza and Western are also
climatically disadvantaged.
WHO
classifies the two regions — as well as the Coast— as “malaria endemic”.
Their location in low altitude areas, which range from 0 to 1,300
metres above sea level, makes it easy for malaria to spread.
Malaria,
a disease caused by the plasmodium parasite that cannot thrive in the
cold, high-altitude climate in Central Kenya, contributes greatly to the
fatalities among children in Western and Nyanza.
The
rainfall, temperature, and humidity in Nyanza shortens the life cycle
of the plasmodium vector and increases its chances of survival for
throughout the year.
Then there is a complicated issue involving the prevalence of HIV, a woman’s level of education and poverty.
Nyanza
and the Coast have always recorded very high rates of teenage
pregnancies, a factor that has kept many girls out of school.
Teachers in the affected areas like Kilifi, Homa Bay and Malindi cited poverty as a cause for these pregnancies.
Between
2012 and 2013, 17 girls dropped out of Nyajanja Secondary School in
Kochia, Homa Bay County, alarming Mr Samuel Odhiambo Okelo, the
principal, who had worked there for barely two years.
Most
of these girls lack even the bare essentials like food and sanitary
towels at home and when they can get them through men, the results are
pregnancies,” he said.
According
to the survey, 19.2 per cent of girls aged between 15 and 19 in Homa Bay
County have already had a live birth, while 22.2 per cent within this
age group are already married and, therefore, expected to have children.
In addition, contraception uptake among women aged 15 to 49 in the county is below average, standing at 46.7 per cent.
While
youngsters between the ages of 15 and 19 in this region are sexually
active, their use of contraception, even as disease preventing measures
such as condom use, is the lowest, standing at below 5 per cent.
With a high incidence of pregnancies among young girls, enrolment in school is very low in the affected areas.
It
is, therefore, hardly surprising that the report indicated that only 30
per cent of young mothers (under the age of 18) sought medical
attention before, during and after delivery.
Nyamira County defies Nyanza trend
It is notable that Nyamira County’s health indicators stood in start contrast to the general trend in Nyanza.
Nyamira
had the fewest cases of diarrhoea and ARIs, with only 3 per cent, the
highest vaccination coverage (95 per cent), and a very low fever
presence in children (5.7 per cent).
The
county’s chief medical officer, in the Department of Health services,
Mr Douglas Bosire, said that the county had spent the largest portion of
its health budget on preventive and promotive medicine (Sh
150million), than on curative medicine, planning and administrative
issues.
Mr Bosire attributed the
commendable medical seeking behaviour of the people in the county to the
strong community health network.
“They have taught people about toilets, using water properly, handling food and other issues about sanitation,” he explained.
***
FYI
According
to World Health Organisation guidelines, a child is considered to have
received all the basic vaccinations after being inoculated against the
following diseases: tuberculosis, which is also known as
BCG;
three doses each of the DPT-HepB-Hib, which prevents diphtheria;
whooping cough (pertussis); tetanus, also referred to as pentavalent;
polio; and measles.
Severe
diarrhoea, which causes dehydration, has been implicated in many WHO
studies as a major cause of sickness and mortality among young children.
The
counties with the highest cases of ARIs used firewood and charcoal as a
primary source of energy for domestic use. Interestingly, studies have
implicated firewood as a probable cause of indoor
pollution, leading to respiratory illnesses.
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