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

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.

Figure 1

Annualised percentage change in all-cause mortality rates in Kenya, by sex Each coloured line represents the annualised percentage change in all-cause mortality rate for males and females across all age ranges. Shaded areas indicate 95% uncertainty intervals. Early neonatal=age 0–6 days. Late neonatal=age 7–27 days. Post neonatal=age 28–364 days.

Figure 2

Attribution of changes in life expectancy in Kenya and its counties to changes in major groups of causes of death Periods shown are (A) 1990 to 2006, (B) 2006 to 2016, and (C) 1990 to 2016. Life expectancy is shown for both sexes. Life expectancy at the beginning of each period is indicated by a purple bar; life expectancy at the end of each period is indicated by a black bar. Counties are listed in decreasing order of life expectancy at the end of each period.

Figure 3

Observed and expected HALE in Kenya and its counties in 1990 and 2016 Observed and expected HALEs are based on SDI for both sexes. Counties are grouped in colours by former provinces. The black line represents 1:1 observed to expected HALE. Points above the line have higher HALE than predicted by SDI; points below the line have lower HALE than predicted by SDI. HALE=healthy average life expectancy. SDI=Socio-demographic Index.

Figure 4

Rankings of leading risk factors attributable to age-standardised DALYs in Kenya and its counties GBD level 2 risk factors in (A) 1990 and (B) 2016 are ranked from 1 (leading) to 10 or more (lowest) and are based on attributable age-standardised DALYs in both sexes. DALYs=disability-adjusted life-years. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.

Figure 5

Age-standardised rates of DALYs in Kenyan counties in 1990 and 2016 for both sexes DALYs=disability-adjusted life-years.

Figure 6

Annualised percentage change in HIV/AIDS-specific mortality rates for males and females Each coloured line represents the annualised percentage change in HIV/AIDS mortality for males and females across all age ranges. Shaded areas indicate 95% uncertainty intervals. Early neonatal and late neonatal are not estimated for HIV/AIDS. Post neonatal=age 28–364 days.

Figure 7

Age-standardised rates of YLLs and YLDs in Kenya Rates of YLLs and YLDs in 1990 and 2016 attributable to (A) lower respiratory infections and (B) diarrhoea are shown for both sexes by county. LRI=lower respiratory infection. YLD=years lived with disability. YLL=years of life lost.