Factors associated with unfavourable birth outcomes in Kenya

Studies addressing factors associated with adverse birth outcomes have almo st exclusively been based on hospital statistics. This is a serious limitat ion in developing countries where the majority of births do not occur withi n health facilities. This paper examines factors associated with premature deliveries, small baby's size at birth and Caesarean section deliveries in Kenya based on the 1993 Kenya Demographic and Health Survey data. Due to th e hierarchical nature of the data, the analysis uses multilevel logistic re gression models to take into account: the family and community effects. The results show that the odds of unfavourable birth outcomes are significantl y higher for first births than for higher order births. Furthermore, antena tal care (measured by frequency of antenatal care visits and tetanus toroid injection) is observed to have a negative association with the incidence o f premature births. For the baby's size at birth, maternal nutritional stat us is observed to be a predominant factor. Short maternal stature is confir med as a significant risk factor for Caesarean section deliveries. The obse rved higher odds of Caesarean section deliveries among women from household s of high socioeconomic status are attributed to the expected association b etween socioeconomic status and the use of appropriate maternal health care services. The odds of unfavourable birth outcomes vary significantly betwe en women. In addition, the odds of Caesarean section deliveries vary betwee n districts, after taking into account the individual-level characteristics of the woman.