The number of children dying before their fifth birthday in Kenya has risen in the past 10 years, according to health specialists.

One in nine children dies before the age of five. "For every 1,000 children born, 121 die, compared with 97 in 1990," Shahnaz Sharif, the senior deputy director of medical services in Kenya's health ministry, told IRIN.

"A shortage of skilled health workers and a lack of access to referral facilities are partly to blame for the increasing deaths," Sharif said.

According to briefing notes by the UN Children's Fund (UNICEF), the main direct causes of the high neonatal (0–27 days after birth) deaths include infection, pre-term birth, low birth weight and birth asphyxia.

About 10 million children under-five die each year, according to the UN World Health Organization (WHO) World Health Report. Under-nutrition is the underlying cause for at least 30 percent of the deaths.

Delays in recognising newborn danger signs as well as in making referrals to health facilities also contributed to the deaths.

"They [the children] are dying because the families do not have access to simple low-cost and highly effective interventions," according to UNICEF. These include exclusive breast-feeding, prompt treatment of malaria and pneumonia, immunisation and prevention of mother to child HIV infection.

Malaria kills 90 children under-five daily in Kenya and is a cause of low birth weight in almost 25,000 births. The goal of eliminating maternal neo-natal tetanus also continues to remain elusive, said UNICEF, adding that there had been a decrease in immunisation coverage from 82 percent in 1996 to 59 percent in 2003.

Related to the child deaths are high death rates among pregnant women and recently delivered women, especially within communities where birth attendants are unskilled and lack capacity to deal with emergencies.

Home deliveries are especially risky yet account for about 60 percent of all deliveries nationally; in northern parts of Kenya, more than 90 percent of deliveries take place at home, according to UNICEF.
Maternal deaths

Maternal mortality figures are still high, despite falling from 590 deaths per 100,000 in 1998 to 414 in 2003. "At least 16 pregnant or newly delivered women die in Kenya every day," said Sharif. 

The main causes of death are excessive bleeding, infections, malaria, hypertension, unsafe abortions and obstructed labour, he said. Pregnancy-related complications account for almost 15 percent of deaths in women of reproductive age worldwide, according to the WHO.

"Delays in making decisions and lack of prior preparedness for obstetric emergencies are major causes of maternal deaths," stated UNICEF.

Sharif said the government was providing maternal shelters for pregnant women to use two weeks before they are due in areas where health facilities are hard to reach. The training of traditional birth attendants is ongoing.

The government has also distributed more than three million long-lasting insecticide-treated bed nets in the last few years for pregnant women and under-fives. And, with UNICEF, it launched the “Malezi bora” (healthy upbringing) campaign, which provides information on breast-feeding, diarrhoea control, immunisation, child spacing and malaria control.

More, however, needs to be done. "More money should be put into interventions with an impact on neo-natal and maternal health," Sharif said.

"Additional staff should also be trained to make sure that all deliveries are attended to by skilled workers," he said. 

"With political will we will get the necessary resources as right now interest is mainly focused on HIV and malaria prevention," he said. "When nobody pays attention to the mother in labour it contributes to neo-natal problems."
    
According to WHO, almost one in five deaths in the world was a child under-five in 2004: "In Africa, death takes the young."

IRIN