The influence of socioeconomic and demographic factors on rural-urban disparities in infant mortality in Kakamega Central Sub-County, Kakamega County, Kenya

Gilbert Omedi, Irene Mutavi, Joyce Obuoyo
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Abstract

Background: Infant mortality, measured as the summation of neonatal and post-neonatal mortalities, remain unacceptably high in Kakamega Central Sub-County, Kakamega County, Kenya. Reducing infant mortality is paramount not only in assessing the progress made towards the third sustainable development goal but also in creating a conducive environment for fertility reduction and in giving a chance to new-born babies to live out their social and economic potential in their families and societies at large. Objective: This study sought to establish the influence of socioeconomic and demographic factors on rural – urban disparities in infant mortality in Kakamega Central Sub - County, Kakamega County, Kenya. Methods: A cross-sectional research design was used. Systematic random sampling was employed to obtain a sample of 422 mothers within the reproductive age range of 15 to 49 years. Purposive sampling was used to arrive at key informants that were engaged in the study. Primary data were collected from December 2022 to January 2023 by administering pretested and validated questionnaires and interviewing key informants. Descriptive statistics and multinomial logistic regression analyses were conducted on the Statistical Package for Social Sciences computer software to estimate the prevalence of infant mortality and the odds ratio used as a measure of association at ρ<0.05. Results: Results of multivariate analysis indicated that there were higher likelihoods of rural neonatal (aOR = 1.913) and urban post-neonatal (aOR = 3.823) mortalities amongst mothers with no education qualifications. There were reduced likelihoods of rural post-neonatal (aOR = 0.105) and urban neonatal (aOR = 0.108) mortalities amongst mothers working in the professional, technical, managerial and clerical sectors. Both young (aOR = 1.579 for neonatal mortality) and old (aOR = 2.742 for infant mortality) ages at motherhood, and first births (aOR = 3.492 for infant mortality) and births of high orders (1.881 for neonatal mortality) were associated with increased likelihoods of mortalities in urban and rural areas, respectively. Urban mothers who observed a ≤ 24 months wait period prior to an index birth were more likely to report both post-neonatal (aOR = 3.294) and infant (aOR = 3.616) mortalities. Conclusions: The major contributors to the rural - urban disparities in infant mortality in Kakamega Central Sub-County were order of the index birth, which was significant only in rural areas, and wait period prior to the index birth, which was significant only in urban areas, after controlling for the confounding variables. It is important to advocate for childbearing during the middle reproductive ages and widen the wait period between successive births so as to improve the maturity of the mother and reduce parity, both of which correlate with low infant mortality. Future studies should be done on the relationship between marital status of the mother and infant mortality.
社会经济和人口因素对肯尼亚卡卡梅加县卡卡梅加中央子县城乡婴儿死亡率差异的影响
背景:在肯尼亚卡卡梅加县卡卡梅加中央子县,婴儿死亡率(新生儿死亡率和新生儿后期死亡率的总和)仍然高得令人无法接受。降低婴儿死亡率不仅对评估实现第三个可持续发展目标的进展情况至关重要,而且对创造有利于降低生育率的环境以及让新生儿有机会在家庭和整个社会中发挥其社会和经济潜力也至关重要。研究目的本研究旨在确定社会经济和人口因素对肯尼亚卡卡梅加县卡卡梅加中央子县城乡婴儿死亡率差异的影响。研究方法采用横断面研究设计。采用系统随机抽样法获得了 422 名 15 至 49 岁育龄妇女样本。采用了目的性抽样,以获得参与研究的关键信息提供者。在 2022 年 12 月至 2023 年 1 月期间,通过发放经过预先测试和验证的问卷以及采访主要信息提供者,收集了原始数据。使用社会科学统计软件包(Statistical Package for Social Sciences)进行了描述性统计和多项式逻辑回归分析,以估算婴儿死亡率的发生率,并使用几率比(odds ratio)来衡量ρ<0.05时的相关性。结果显示多变量分析结果表明,在没有受过教育的母亲中,农村新生儿死亡率(aOR = 1.913)和城市新生儿后期死亡率(aOR = 3.823)较高。在专业、技术、管理和文职部门工作的母亲中,农村新生儿后期(aOR = 0.105)和城市新生儿(aOR = 0.108)死亡的可能性降低。在城市和农村地区,年轻(新生儿死亡率的 aOR = 1.579)和高龄(婴儿死亡率的 aOR = 2.742)孕产妇、初产妇(婴儿死亡率的 aOR = 3.492)和高产妇(新生儿死亡率的 aOR = 1.881)分别与死亡率的增加有关。在指数分娩前等待时间少于 24 个月的城市母亲更有可能报告新生儿出生后(aOR = 3.294)和婴儿(aOR = 3.616)死亡。结论在控制了混杂变量后,造成卡卡梅加中央子县城乡婴儿死亡率差异的主要因素是分娩顺序(仅在农村地区显著)和分娩前等待时间(仅在城市地区显著)。重要的是要提倡在生育中期生育,并延长连续生育之间的等待期,以提高母亲的成熟度并减少奇偶数,这两者都与低婴儿死亡率相关。今后应对母亲的婚姻状况与婴儿死亡率之间的关系进行研究。
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