Health disparities across the counties of Kenya and implications for policy makers, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Tom Achoki; Molly K Miller-Petrie; Scott D Glenn; Nikhila Kalra; Abaleng Lesego; Gladwell K Gathecha; Uzma Alam; Helen W Kiarie; Isabella Wanjiku Maina; Ifedayo M O Adetifa; Hellen C Barsosio; Tizta Tilahun Degfie; Peter Njenga Keiyoro; Daniel N Kiirithio; Yohannes Kinfu; Damaris K Kinyoki; James M Kisia; Varsha Sarah Krish; Abraham K Lagat; Meghan D Mooney; Wilkister Nyaora Moturi; Charles Richard James Newton; Josephine W Ngunjiri; Molly R Nixon; David O Soti; Steven Van De Vijver; Gerald Yonga; Simon I Hay; Christopher J L Murray; Mohsen Naghavi

doi:10.1016/S2214-109X(18)30472-8

Health disparities across the counties of Kenya and implications for policy makers, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Lancet Glob Health. 2019 Jan;7(1):e81-e95. doi: 10.1016/S2214-109X(18)30472-8. Epub 2018 Oct 25.

Authors

Tom Achoki¹, Molly K Miller-Petrie², Scott D Glenn², Nikhila Kalra², Abaleng Lesego³, Gladwell K Gathecha⁴, Uzma Alam⁵, Helen W Kiarie⁴, Isabella Wanjiku Maina⁶, Ifedayo M O Adetifa⁷, Hellen C Barsosio⁸, Tizta Tilahun Degfie⁹, Peter Njenga Keiyoro¹⁰, Daniel N Kiirithio¹¹, Yohannes Kinfu¹², Damaris K Kinyoki², James M Kisia¹³, Varsha Sarah Krish², Abraham K Lagat¹⁴, Meghan D Mooney², Wilkister Nyaora Moturi¹⁵, Charles Richard James Newton¹⁶, Josephine W Ngunjiri¹⁷, Molly R Nixon², David O Soti¹⁸, Steven Van De Vijver¹⁹, Gerald Yonga²⁰, Simon I Hay²¹, Christopher J L Murray²¹, Mohsen Naghavi²²

Affiliations

¹ Sloan Management, Massachusetts Institute of Technology, Cambridge, MA, USA; Center for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, Netherlands.
² Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
³ Strategic Information and Learning, University of Research Company, Gaborone, Botswana.
⁴ Ministry of Health, Nairobi, Kenya.
⁵ International Center for Humanitarian Affairs, Nairobi, Kenya.
⁶ Policy, Planning, and Healthcare Financing Department, Nairobi, Kenya; Institute of Tropical Medicine, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
⁷ Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Epidemiology and Demography Department, Kilifi, Kenya.
⁸ Malaria Branch, Kilifi, Kenya; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
⁹ Population Dynamics and Reproductive Health Unit, Nairobi, Kenya.
¹⁰ ODeL Campus, University of Nairobi, Nairobi, Kenya.
¹¹ Synotech Consultants, Nairobi, Kenya.
¹² Faculty of Health, University of Canberra, Canberra, ACT, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Vic, Australia.
¹³ East Africa Center, Humanitarian Leadership Academy, Nairobi, Kenya.
¹⁴ Department of Health Systems and Research Ethics, KEMRI-Wellcome Research Programme, Nairobi, Kenya.
¹⁵ Department of Environmental Science, Egerton University, Egerton, Kenya.
¹⁶ Kenya Medical Research Institute (KEMRI)-Wellcome Trust Collaborative Programme, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK.
¹⁷ Department of Biological Sciences, University of Embu, Embu, Kenya.
¹⁸ Eastern Africa Regional Collaborating Centre, African Centre for Disease Control and Prevention, Nairobi, Kenya.
¹⁹ African Population Health Research Centre, Nairobi, Kenya.
²⁰ School of Medicine, University of Nairobi, Nairobi, Kenya.
²¹ Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
²² Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA. Electronic address: [email protected].

Abstract

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provided comprehensive estimates of health loss globally. Decision makers in Kenya can use GBD subnational data to target health interventions and address county-level variation in the burden of disease.

Methods: We used GBD 2016 estimates of life expectancy at birth, healthy life expectancy, all-cause and cause-specific mortality, years of life lost, years lived with disability, disability-adjusted life-years, and risk factors to analyse health by age and sex at the national and county levels in Kenya from 1990 to 2016.

Findings: The national all-cause mortality rate decreased from 850·3 (95% uncertainty interval [UI] 829·8-871·1) deaths per 100 000 in 1990 to 579·0 (562·1-596·0) deaths per 100 000 in 2016. Under-5 mortality declined from 95·4 (95% UI 90·1-101·3) deaths per 1000 livebirths in 1990 to 43·4 (36·9-51·2) deaths per 1000 livebirths in 2016, and maternal mortality fell from 315·7 (242·9-399·4) deaths per 100 000 in 1990 to 257·6 (195·1-335·3) deaths per 100 000 in 2016, with steeper declines after 2006 and heterogeneously across counties. Life expectancy at birth increased by 5·4 (95% UI 3·7-7·2) years, with higher gains in females than males in all but ten counties. Unsafe water, sanitation, and handwashing, unsafe sex, and malnutrition were the leading national risk factors in 2016.

Interpretation: Health outcomes have improved in Kenya since 2006. The burden of communicable diseases decreased but continues to predominate the total disease burden in 2016, whereas the non-communicable disease burden increased. Health gains varied strikingly across counties, indicating targeted approaches for health policy are necessary.

Funding: Bill & Melinda Gates Foundation.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Administrative Personnel*
Global Burden of Disease / statistics & numerical data*
Health Policy*
Health Status Disparities*
Humans
Kenya / epidemiology