HIV and Increases in Childhood Mortality in Kenya in the Late 1980s to the Mid-1990s

Controversy surrounds the factors responsible for the increase in child mortality in the 1990s and the objective of this paper is to clarify the situation. Data from the 1993 and 1998 KDHSs have been merged into a single data set and multivariate analysis has been used to examine the factors associated with mortality risks in childhood. Dummy variables were used to represent different three-year time periods from 1984-86 to 1996-98. Socioeconomic controls including mother’s education an indicator of household wealth urban/rural residence and indicators of health service use plus controls for reproductive dynamics (such as age of mother at the birth birth order sex and preceding birth interval) were introduced into the model. In addition an indicator of the HIV epidemic the estimated prevalence of HIV in the district of birth at the time of each child’s birth was incorporated. With no controls the analysis confirmed an increase in mortality of about 20 percent from 1984-86 to the highest risk period 1994-96. Including socioeconomic and biodemographic controls tended to strengthen the upward trend in mortality indicating that the net effect of changes in these factors was toward reducing child mortality primarily because of a major favorable shift in the distribution of births by education of mother. Introducing controls for health variables—immunization pregnancy and delivery care and maternal and child malnutrition—barely changed the underlying trend between 1990-92 and 1996-98 suggesting that although use of preventive health services declined somewhat it did not have a major effect on child mortality risks. The effect of district-level prevalence of HIV however is significantly positive suggesting an increase in risk of about 5 percent per 1 percent increase in HIV prevalence. Including the HIV prevalence also changed the underlying trends fundamentally to a sharp and monotonic decline. Although models of this sort can only demonstrate association the HIV epidemic appears to have played a major role in the recent increases in child mortality in Kenya. (excerpt)