Under-five mortality in the Rongo Sub-County of Migori County, Kenya: Experience of the Lwala Community Alliance 2007-2017 with evidence from a cross-sectional survey

INTRODUCTION: Childhood mortality remains a pressing problem in rural Kenya, and reducing under-five deaths is a key target of the Sustainable Development Goals. We aim to describe the reduction in under-five mortality in a rural Kenyan community served by the Lwala Community Alliance and factors associated with under-five mortality in this community. METHODS: A cross-sectional survey containing a complete birth history was administered to a representative sample of the catchment area of the Lwala Community Alliance. Survival analysis techniques were used to describe temporal trends and risk factors related to under-five mortality. RESULTS: 1,362 children were included in the study, and 91 children died before the fifth birthday. The most common causes of death among children under five were malaria (19%), respiratory infection (13%), and anemia (11%). The under-five mortality rate was 104.8 per 1,000 live births from 1999 to 2006 and 53.0 per 1,000 after the founding of the Lwala Community Alliance in 2007. Factors associated with under-five mortality included year of birth (HR 0.931; 95% CI: 0.877, 0.988; p = 0.019), multiple-gestation pregnancy (HR 6.201; 95% CI: 2.073, 18.555; p < 0.001), and birth in the long rain season (HR 1.981; 95% CI: 1.350, 2.907; p < 0.001). Birth spacing greater than 18 months was negatively associated with under-five mortality (HR 0.345; 95% CI: 0.203, 0.587; p < 0.001). CONCLUSIONS: There was a significant decrease in under-five mortality before and after the presence of the Lwala Community Alliance. Multiple-gestation pregnancies, birth season, and short birth spacing were associated with under-five mortality and provide possible targets to further reduce mortality in the region. This provides both hyper-local data necessary for implementation efforts and generalizable data and sampling methods that may be useful for other implementing organizations in sub-Saharan Africa.