title: Trends in childhood mortality in Kenya: the urban advantage has seemingly been wiped out.
abstract: BACKGROUND
  We describe trends in childhood mortality in Kenya, paying attention to the urban-rural and intra-urban differentials.
  
  
  METHODS
  We use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR).
  
  
  RESULTS
  Between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban-rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya.
  
  
  CONCLUSIONS
  The narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums.
authors.affiliation: African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya. Electronic address: ekimani@aphrc.org.
authors.forename: E W
authors.initials: EW
authors.lastname: Kimani-Murage
authors.affiliation: Concern Worldwide, New York, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Fotso
authors.affiliation: African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya.
authors.forename: T
authors.initials: T
authors.lastname: Egondi
authors.affiliation: African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya.
authors.forename: B
authors.initials: B
authors.lastname: Abuya
authors.affiliation: African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya.
authors.forename: P
authors.initials: P
authors.lastname: Elungata
authors.affiliation: African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya.
authors.forename: A K
authors.initials: AK
authors.lastname: Ziraba
authors.affiliation: African Population and Health Research Center (APHRC), P.O. 10787, 00100 Nairobi, Kenya.
authors.forename: C W
authors.initials: CW
authors.lastname: Kabiru
authors.affiliation: Centre for Global Health, Population, Poverty, Policy University of Southampton, Southampton, UK.
authors.forename: N
authors.initials: N
authors.lastname: Madise
mesh_terms: D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011204:Poverty Areas; D012424:Rural Population / Q000706:statistics & numerical data; D014504:Urban Health; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Child mortality; Infant mortality; Sub-Saharan Africa; Under five mortality; Urban slums