A British charity’s recent appeal for donations said the death rates of mothers and young children in Kenya were very high, giving statistics to support the claim.
Penny Appeal works to “provide poverty relief across Asia, the Middle East and Africa”, according to its website
“Kenya has one of the worst maternal mortality rates in the world, and over one in 20 children die before their fifth birthday.”
The appeal was also listed on the UK Aid Match website. This meant that for every pound donated, the UK government would add another from its international development budget. The donations drive ran from 10 March to 9 June 2019.
But do the two stats hold up to scrutiny? We checked.
A maternal death is the death of a woman caused by any stage of pregnancy or by childbirth complications, up to six weeks after delivery.
The cause of death could be direct (such as excessive bleeding) or indirect (when pregnancy aggravates an existing condition such as kidney problems), but accidental deaths are excluded.
To get the maternal mortality rate, the average annual number of maternal deaths in a population is divided by the female population of reproductive age (typically those aged 15 to 49 years). This is according to the World Health Organization (WHO).
The rate is not the same as the more commonly used mortality ratio, which gives the number of maternal deaths in relation to the number of live births. The two measures should not be used interchangeably, Dr Doris Chou, a medical officer with the department of reproductive health and research at the WHO, told Africa Check.
“These are all statistical measures and if someone wants to compare then you need to compare MMRatio to MMRatio and MMRate to MMRate, collected in the same methodology,” Chou said.
There were data series comparing the maternal mortality rate between some countries, but she hadn’t come across a “full series” that compared all countries.
Charity’s claim ‘not off the mark’
Data on the maternal mortality ratio, on the other hand, is widely available. According to the most recent statistics from UN Maternal Mortality Estimation Inter-Agency Group, Kenya is one of 21 countries with a very high ratio of maternal deaths.
The data covered 1990 to 2015 and showed Kenya had 510 maternal deaths for every 100,000 live births. Nigeria and India accounted for 34% of all maternal deaths, with sub-Saharan Africa countries accounting for 20 of the 21 countries.
“So it is not ‘off the mark’ for the charity to make such a claim,” Chou said.
The Kenya Demographic and Health Survey found a maternal mortality ratio of 362 deaths per 100,000 live births from 2007 to 2014. The WHO previously told Africa Check that this survey was not available when the UN group was modelling the estimates in 2015. If it had been, the agency’s best estimate would have been much closer to Kenya’s.
An update to the UN’s estimates was due in the next few months, Chou said.
Dr Gershim Asiki, an associate research scientist at the Africa Population and Health Research Center, agreed. “Even 360 [maternal deaths per 100,000] is bad enough to be among one of the highest in the world. I would not ignore such figures as claims, provided they quote the data source,” Asiki told Africa Check.
We therefore rate this claim as mostly correct.
The source of this claim was “a Unicef report from 2018 which is the most up-to-date statistics available at the moment”, Penny Appeal told Africa Check.
The charity shared a link to data on Kenya by the UN Children’s Fund, known as Unicef. This gave the under-five mortality rate – the number of kids who die before their fifth birthday – as 45.6 deaths per 1,000 live births.
There were 52 deaths per 1,000 live births in 2014, the most recent year for which the Kenya Demographic and Health Survey has data.
Kenya’s national statistics office told Africa Check that the next survey would be done in 2019 and 2020.
There are more recent estimates. The 2018 Levels & Trends in Child Mortality report, released in September 2018, has internationally comparable data.
The report is produced by the UN Inter-agency group for child mortality estimation, which includes Unicef, the WHO, the World Bank and the UN Population Division.
‘One in 20 a fair statement’
They estimated that Kenya’s under five mortality was 45.6 deaths per 1,000 live births in 2017 – the figure used by the charity.
Dr Robert Black, a US epidemiologist who studies child deaths, told Africa Check that not all births and deaths are recorded, so registration data isn’t used to estimate this mortality rate. In 2018, for example, Kenya registered 73.6% of its births and just 38.9% of its deaths, according to the 2019 Economic Survey.
Black is based at Johns Hopkins Bloomberg School of Public Health in Baltimore, US. He was also a technical advisor for the UN report.
Instead of registration data, he said, “data from national surveys that ask about births and deaths are used to estimate the mortality rate”.
Black said although the actual rate was lower than the claim, it was “reasonable”.
“The reported value is 46 per 1000 live births which is slightly less than one in 20 which would be 50 per 1,000. For simplicity I think that one in 20 is a fair statement,” Black told Africa Check.
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