Determinants of Neonatal and Under-five Mortality in Kenya: Do Antenatal and Skilled Delivery Care Services Matter?

Declines in neonatal and under-five mortality in Kenya were much slower than what was required to meet the Millennium Development Goal (MDG) on childhood mortality. Therefore, while Tanzania and Uganda met and surpassed their MDG targets, Kenya did not. Effort is now directed at ending all preventable deaths among neonates and under-fives, as envisaged in the Sustainable Development Goals (SDGs). Most childhood mortality can be prevented by ensuring that women have access to quality care during conception, pregnancy, intra-partum and in the post-natal period. This study investigated the effects of antenatal and skilled delivery care services on neonatal and under-five mortality in Kenya using pooled Kenya demographic and health survey data for 1998, 2003, 2008/2009 and 2014. Two-stage residual inclusion estimation procedure and the control function approach were used to test and control for potential endogeneity of antenatal and skilled delivery care and for potential unobserved heterogeneity. The study unveiled presence of both endogeneity and unobserved heterogeneity and found that failure to control these would have biased downwards the effects of antenatal and skilled delivery care services on childhood mortality. Findings indicated that adequate use of antenatal care services reduced risk of neonatal and under-five mortality by 2.4 and 4.2 percentage points respectively. Similarly|| use of skilled delivery care services was associated with reduced risk of neonatal and under-five mortality by 0.3 and 1.8 percentage points respectively. Increasing coverage of women using adequate antenatal care services and skilled delivery care services can reduce the risk of neonatal and under-five mortality in Kenya. Policies that promote use of these services such as promoting women education and reducing average distances to health facilities should be promoted.