Abstract:
Background: To improve child survival, it is necessary to describe and understand the spatial and
temporal variation of factors associated with child survival beyond national aggregates, anchored
at decentralised health planning units. Therefore, we aimed to provide subnational estimates of
factors associated with child survival while elucidating areas of progress, stagnation and decline
in Kenya.
Methods: Twenty household surveys and three population censuses conducted since 1989 were
assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatiotemporal Gaussian process regression models accounting for inadequate sample size and spatiotemporal relatedness were fitted for 43 factors at county level between 1993 and 2014.
Results: Nationally, the coverage and prevalence were highly variable with 38 factors recording
an improvement. The absolute percentage change (1993-2014) was heterogeneous ranging
between 1% and 898%. At the county level, the estimates varied across space and over time with
a majority showing improvements after 2008 which was preceded by a period of deterioration
(late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower
coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya
had and historically have had higher coverage across all intervention domains. Most factors in
Western and South-East Kenya recorded moderate intervention coverage although having a high
infection prevalence of both HIV and malaria.
Conclusion: The heterogeneous estimates necessitates prioritisation of the marginalised counties
to achieve health equity and improve child survival uniformly across the country. Efforts are
required to narrow the gap between counties across all the drivers of child survival. The generated
estimates will facilitate improved benchmarking and establish a baseline for monitoring child
development goals at subnational level.