Onsomu, Lydia Kemun o; Ng'eno, Ha on
A icle
The impo ance o in es ing in he i s 1000 days o li e:
E idence and policy op ions
Economies
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Sugges ed Ci a ion: Onsomu, Lydia Kemun o; Ng'eno, Ha on (2025) : The impo ance o in es ing in
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Ci a ion: Onsomu, L. K., & Ng’eno, H.
(2025). The Impo ance o In es ing in
he Fi s 1000 Days o Li e: E idence
and Policy Op ions. Economies,13(4),
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A icle
The Impo ance o In es ing in he Fi s 1000 Days o Li e:
E idence and Policy Op ions
Lydia Kemun o Onsomu 1,* and Ha on Ng’eno 2,*
1Depa men o Paedia ics and Child Heal h, Uni e si y o Nai obi (UON),
Nai obi P.O Box 19676-00202, Kenya
2School o Economics, Depa men o Applied Economics, Kenya a Uni e si y (KU),
Nai obi P.O. Box 43844-00100, Kenya
*Co espondence: [email p o ec ed] (L.K.O.); [email p o ec ed] (H.N.)
Abs ac : The i s 1000 days o li e s a s om concep ion o a child’s second bi hday.
Resea ch sugges s ha he pe iod is c i ical o cogni i e, physical, and emo ional de elop-
men . In es men s in ma e nal and child heal hca e du ing his pe iod ha e a p o ound
impac on long- e m heal h, educa ional a ainmen , and economic p oduc i i y. This s udy
examined he impac o such in es men s on child heal h ou comes in Kenya, using da a
om he 2015/2016 Kenya In eg a ed Household Budge Su ey (KIHBS). Key a eas o
ocus included ma e nal heal hca e, ea ly an ena al ca e, skilled deli e y, exclusi e b eas -
eeding, p ope weaning p ac ices, immuniza ion, and he imely ea men o childhood
illnesses. Using he Cox eg ession haza d model, he s udy e ealed ha wins aced a
highe isk o mo ali y compa ed o single bi hs, while i s bo ns we e less likely o die
be o e hei i h bi hday; la ge household sizes we e associa ed wi h educed child mo -
ali y, and child en in emale-headed households had a lowe likelihood o dying, likely due
o be e adhe ence o p ope heal h and nu i ional p ac ices. Ma e nal heal h condi ions,
he place o deli e y, and assis ance du ing childbi h signi ican ly in luenced su i al,
wi h go e nmen heal h acili y deli e ies yielding be e ou comes han homebi hs. This
s udy emphasizes he impo ance o educa ing p egnan women and mo he s on heal h
isks and public heal h p o ocols du ing his c i ical pe iod. S eng hening heal hca e
sys ems and p omo ing equi able access o essen ial se ices du ing he i s 1000 days
could imp o e child su i al a es and enhance long- e m economic p oduc i i y.
Keywo ds: in es ing i s 1000 days Kenya; Cox haza d eg ession
1. In oduc ion
The i s 1000 days o li e e e s o he pe iod om concep ion o he second bi hday
in a child’s li e, ha is, ges a ion, in ancy, and oddle hood. This is an impo an pe iod
since he body is unde going signi ican b ain, physical, and immuni y de elopmen , as
well as neu ode elopmen (Sane uji e al.,2021). The pe iod is, he e o e, impo an o
public heal h in e en ions ha will suppo child de elopmen du ing his c i ical pe iod,
p e en ing de iciencies, such as malnu i ion and in ec ions, ha become coun e p oduc-
i e o he child’s heal h and esul in nega i e economic impac s. The i s 1000 days
o li e also play a c ucial ole in human capi al o ma ion, a undamen al d i e o eco-
nomic de elopmen (Ma o ell,2018). This c i ical pe iod has las ing e ec s on a child’s
u u e heal h, de elopmen , and p oduc i i y in adul hood. The Sou h A ican Child
Gauge highligh s how ea ly li e expe iences se e as he ounda ion o human capi al
de elopmen (Jamieson e al.,2017). A heal hy p egnancy, ollowed by adequa e child
Economies 2025,13, 105 h ps://doi.o g/10.3390/economies13040105
Economies 2025,13, 105 2 o 22
heal hca e and suppo i e pa en ing, posi i ely in luences a child’s educa ional a ainmen
and smoo h ansi ion in o he wo k o ce, ul ima ely con ibu ing o sus ained economic
g ow h and de elopmen .
Human capi al cons i u es he impac o heal h and educa ion on p oduc i i y in he
wo kplace. Wi h a p ima y ocus on human capi al o ma ion, i is impo an o ecognize
ha human capi al begins om he ime o concep ion, h ough p egnancy, o he deli e y
o a child and hei de elopmen o adul hood. A s udy published by he In e na ional
Ins i u e o Applied Sys ems Analysis (IIASA) in 2008 compa ed demog aphic and human
capi al ends in Eas e n Eu ope and in Sub-Saha an A ica. The wo ld was o ecas ed
o ha e wo majo demog aphic occu ences in wo decades: apid popula ion g ow h
and apid popula ion ageing (Lu z e al.,2008). F om he s udy, Sub-Saha an A ica was
p edic ed o expe ience a popula ion explosion ha would boos he wo k o ce, while
Eas e n Eu ope would expe ience a popula ion sh ink. I , howe e , also b ough up
an in e se co ela ion be ween popula ion g ow h and educa ion a ainmen , p edic ing
highe pe capi a p oduc i i y in Eas e n Eu ope owing o inc eased educa ion a ainmen
among he adul wo king popula ion as compa ed o Sub-Saha an A ica. The Human
Capi al Index (HCI) comp ises six inpu s in heal h and educa ion. The heal h inpu s a e
he p obabili y o a child su i ing o he age o 5 yea s, he adul su i al a e, and he
p opo ion o child en wi hou s un ed g ow h. The educa ion inpu s a e he expec ed
yea s o schooling, ha monized es sco es, and he lea ning-adjus ed yea s o school. The
HCI o Kenya in 2018 was 52%, ela i e o a global a e age o 56%. This implies ha a
child bo n in Kenya oday will ha e a p oduc i i y o 52%, ela i e o wha i could be i
he child enjoyed ull heal h and comple ed hei educa ion. The Seychelles and Mau i ius
a e he bes pe o ming among he Sub-Saha an A ican coun ies, wi h HCIs o 68% and
63%, espec i ely. The main ac o s explaining he le el o he HCI include heal h ou comes
since he p oduc i i y o indi iduals is highly dependen on he quali y o hei heal h and
ea ly in es men in he educa ion hey ecei e. Sub-Saha an A ica was no ed o ha e a
low HCI o 0.57 in 2020 as i has highe mo ali y a es om childhood o adul hood, lowe
educa ion le els amongs he popula ion, and highe a es o po e y han do de eloped
na ions (Shobowale e al.,2024).
The child mo ali y a e in child en unde 5 yea s old in Kenya was 43.2 dea hs pe
1000 li e bi hs in 2021, ha ing imp o ed om 52 pe 1000 li e bi hs (KNBS,2015). The
a es ha e been imp o ing o e he yea s, bu he coun y has no eached he se a ge .
The SDG a ge 3.2 aims o educe he unde -5 mo ali y a e o less han 25 dea hs pe
1000 li e bi hs and he neona al mo ali y a e o less han 12 dea hs pe 1000 li e bi hs.
The coun y can only each his a ge once he e is adequa e ea men and p e en ion
o he common causes o child mo ali y, which a e pneumonia, dia hea, mala ia, and
malnu i ion. The mo bidi ies accoun o a hi d o he causes o child mo bidi ies.
Low in es men in a child’s ea ly days o li e has been associa ed wi h s un ing,
becoming unde weigh , and was ing, which ha e long- e m implica ions on human capi al
accumula ion. Acco ding o he KNBS (2015), he p e alence o s un ing was es ima ed a
26%, was ing a 4%, and being unde weigh a 11% in 2014. The le els imp o ed in 2022 o
he p e alence o child s un ing being a 18%, was ing a 5%, and being unde weigh a 10%
(KNBS & ICF,2023). S un ing e e s o an indi idual ha ing a low heigh o hei age and
is a ma ke o ch onic malnu i ion and was ing, which e e s o an indi idual ha ing a low
weigh o hei heigh and is a ma ke o acu e malnu i ion: examples include ma asmus
and kwashio ko . Being unde weigh e e s o an indi idual ha ing a low weigh o hei
heigh and is a combina ion o bo h s un ing and was ing. Unde s anding and p e en ing
malnu i ion is c ucial because i no only exposes he child o oppo unis ic in ec ions bu
also has nega i e e ec s on he physical and men al de elopmen o he child.
Economies 2025,13, 105 3 o 22
Ma e nal heal hca e has emained a majo public heal h conce n ac oss he globe and
mo e so in low- and middle-income coun ies. Speci ically, in Kenya, in 2022, he ma e nal
mo ali y a io (MMR) was 362 ma e nal dea hs pe 100,000 li e bi hs ( ansla ing o abou
6000 ma e nal dea hs pe yea ), and he s illbi h a e was 23 dea hs pe 1000 li e bi hs
( ansla ing o 35,000 s illbi hs pe yea ), a below he a ge o 147 ma e nal mo ali ies
pe 100,000 li e bi hs and 12 s illbi hs pe 1000 li e bi hs by 2030 (KNBS & ICF,2023).
The cu en le els o child unde nu i ion illus a e he con inuing challenges o he
educ ion o child hunge . S a is ics show ha s un ing a ec s 2 in e e y 10 child en unde
5 yea s old (KNBS & ICF,2023). This is way below he Sus ainable De elopmen Goal
(SDG) a ge o educing he pe cen age o s un ed child en o 14.7% by 2030 and has
long- e m e ec s on human capi al de elopmen in he coun y.
Inequi ies in he immuniza ion co e age be ween popula ions in Kenya ha e pe sis ed,
e en wi h he de olu ion o p ima y heal hca e in he coun y. In 2014, he e was a 17.7 pe -
cen age poin di e ence in he DPT3 immuniza ion co e age be ween he highes co e age
in Cen al P o ince and he lowes in No h Eas e n P o ince (WHO,2018). Wi h almos
1.5 million child en bo n each yea in Kenya, ela i ely small p opo ional di e ences in
he immuniza ion co e age be ween subg oups ansla es in o la ge absolu e numbe s o
unde -immunized and ze o-dose child en (UNICEF,2019). In 2022, he accina ion a e
was 76% o child en aged 12–23 mon hs and 61% o child en aged 24–35 mon hs (KNBS
& ICF,2023).
In addi ion, despi e go e nmen e o s o imp o e he li es o p egnan mo he s
and unbo n child en h ough he in oduc ion o a ious heal h p og ams (such as ee
ma e ni y se ices being in oduced in 2013 in all public heal h ins i u ions ac oss he
coun y), he numbe o mo he s u ilizing he se ices is s ill below he a ge s. Mo eo e ,
only abou 61.8% o deli e ies a e a ended by skilled p o ide s (Minis y o Heal h,2018).
The low u iliza ion o ee ma e ni y se ices was linked o pa ien s’ sa is ac ion in p e ious
deli e ies, which was in luenced by he heal hca e wo ke ’s ac i i ies and ac ions owa ds
women in labo . O he ac o s included he mo he ’s le el o educa ion, which played a
ole in demys i ying poo -deli e y-ou come- ela ed belie s and inc eased pa i y (Ngesa
e al.,2021).
I hese issues a e le un esol ed, ela ed illnesses would educe p oduc i i y and
inc ease heal h expendi u e, bu dening Kenya’s economy, while add essing he issues
would lowe unde - i e mo bidi y and mo ali y. The e o e, i is impo an o add ess
he issues ha a ec child en in hei ea ly s ages in li e o imp o ed heal h ou comes
in he u u e and inc eased p oduc i i y la e in li e, especially in he labo ma ke . This
s udy, he e o e, assessed he link be ween in es ing in he i s 1000 days o li e and heal h
ou comes in Kenya using KDHS 2022 da a (KNBS & ICF,2023).
This s udy ocused on he e ec s o in es ing in he i s 1000 days o li e, consequen ly
gi ing each child an oppo uni y o su i e and ealize and maximize hei po en ial
in adul hood, which is impo an o human capi al de elopmen . The basic needs and
se ices du ing he i s 1000 days o li e a e ma e nal heal hca e; child heal hca e; he
mobiliza ion o mo he s o seek ea ly an ena al ca e; inc easing hospi al deli e ies; en-
hancing exclusi e b eas eeding o he i s 6 mon hs o li e; inc easing knowledge on he
p ope weaning die ; immuniza ion; and he ea ly diagnosis and ea men o common
childhood illnesses.
To explo e he e ec s associa ed wi h in es men in he i s 1000 days o li e on child
ou comes in Kenya, his s udy ocused on h ee ques ions. These included (i) assessing he
s a us o he essen ial needs o child en and households wi h child en unde 2 yea s old;
(ii) es ima ing he e ec o access o c i ical se ices on child heal h and mo ali y ou comes;
Economies 2025,13, 105 4 o 22
and (iii) o p o ide policy ecommenda ions o enhance in es men in child en’s heal h
and educe child mo ali ies.
2. The Theo e ical and Empi ical Li e a u e
This s udy is g ounded in he Human Capi al Theo y, which posi s ha in es men s
in heal h, educa ion, and aining enhance indi idual p oduc i i y and income po en-
ial (Ma ginson,2019). The heo y, s emming om Smi h (1776)’s The Weal h o Na ions,
emphasizes educa ion as a capi al good ha is c ucial o economic ans o ma ion and
skill de elopmen . In es men s in child educa ion and heal hca e a e i al o imp o ing
human capi al and economic ou pu (Becke ,1993). Resea ch indica es ha enhancing
child en’s heal h signi ican ly con ibu es o be e educa ional ou comes and p oduc i i y
in adul hood, making i a aluable economic in es men .
The pe iod be ween concep ion o a child’s second bi hday is widely ecognized
as a c i ical pe iod o g ow h and de elopmen . Resea ch highligh s ha in es men s
in ma e nal and child heal hca e du ing his pe iod signi ican ly impac child su i al,
cogni i e de elopmen , and long- e m well-being (M. M. Black e al.,2017). This sec ion
e iews key esea ch on ma e nal heal h, child heal hca e, and essen ial in e en ions ha
shape ou comes o child en unde i e yea s old. A compa a i e s udy (Timaeus & Lush,
1995) o u ban a eas o Ghana, Egyp , B azil, and Thailand wi h an objec i e o assessing he
in a-u ban di e en ials in child heal h o heal h ansi ion clea ly indica ed ha child en’s
heal h is a ec ed by en i onmen al condi ions and he economic s a us o he household.
Child en om be e -o households had lowe dia hea mo bidi y and mo ali y in Egyp ,
Thailand, and B azil. The di e en ials in dia heal diseases by household economic s a us
we e due o di e ences in childca e p ac ices, such as he p epa a ion o weaning oods
and pe sonal hygiene (Timaeus & Lush,1995). Jacoby and Wang (2003) examined he
linkages be ween child mo ali y–mo bidi y and he quali y o he household–communi y
en i onmen in u al and u ban China using a compe ing isks app oach. The s udy
es ablished ha access o immuniza ion educes he dia hea incidence in u al a eas, and
access o mode n sani a ion acili ies like lush oile s educes he dia hea p e alence in
u ban a eas.
Ma e nal heal h plays a pi o al ole in de e mining child su i al and de elopmen .
Acco ding o he Wo ld Heal h O ganiza ion (WHO,2021), complica ions du ing p egnancy
and childbi h con ibu e o a high bu den o neona al mo ali y, wi h 289,000 ma e nal
dea hs, 2.6 million s illbi hs, and 2.7 million neona al dea hs occu ing globally each yea
(Lang’a e al.,2019). E idence sugges s ha ea ly an ena al ca e (ANC), skilled deli e y,
and pos pa um suppo educe ma e nal and in an mo ali y a es (Islam & Tabassum,
2021). In low- and middle-income coun ies (LMICs), access o quali y ma e nal heal hca e
emains a majo challenge, con ibu ing o ad e se bi h ou comes, such as low bi h
weigh s, p e e m bi hs, and pe ina al asphyxia (Salam e al.,2023).
Childhood mo ali y emains a majo conce n, pa icula ly in LMICs whe e unde - i e
dea hs a e o en linked o p e en able in ec ious diseases and malnu i ion (WHO,2021).
S udies show ha o e 45% o unde - i e dea hs a e nu i ion- ela ed (UNICEF,2019).
The high mo ali y a es in he i s i e yea s o li e a e p ima ily due o pneumonia,
dia hea, mala ia, and neona al complica ions, all o which can be mi iga ed h ough imely
immuniza ion, p ope nu i ion, and imp o ed heal hca e access (Vic o a e al.,2016).
Resea ch sugges s ha key in e en ions o child su i al and de elopmen include
access o ea ly an ena al ca e, inc eased skilled assis ance wi h bi hs, hospi al deli e ies,
exclusi e b eas eeding, immuniza ion, p ope weaning, and nu i ional suppo . An ena al
ca e is essen ial in educing p egnancy- ela ed complica ions. Communi y heal h wo ke s
(CHWs) play a c i ical ole in mobilizing mo he s o ANC isi s, p o iding nu i ional
Economies 2025,13, 105 5 o 22
counseling, mic onu ien supplemen a ion, and ea ly sc eening o ma e nal condi ions
(Olani an e al.,2019). ANC educes he isk o p e e m bi h, malnu i ion, and iodine-
de iciency- ela ed cogni i e impai men (M. M. Black e al.,2017).
Skilled bi h a endance signi ican ly educes pe ina al asphyxia, s illbi hs, and pos -
pa um complica ions (WHO,2021). Hospi al deli e ies lowe ma e nal mo ali y a es,
pa icula ly om pos pa um hemo hage and obs uc ed labo (Campbell & G aham,
2006). E idence sugges s ha acili y-based deli e ies wi h skilled pe sonnel could p e en
up o 60% o ma e nal dea hs in LMICs (WHO,2021).
Exclusi e b eas eeding is c ucial o op imal in an nu i ion, immune sys em de el-
opmen , and cogni i e g ow h (Vic o a e al.,2016). The WHO’s Baby-F iendly Hospi al
Ini ia i e (BFHI) p omo es b eas eeding in hospi als; howe e , pos -discha ge suppo is
limi ed, leading o ea ly weaning and inc eased malnu i ion isks (Vic o a e al.,2016). The e
is a need o communi y-based b eas eeding educa ion p og ams o imp o e adhe ence.
The weaning pe iod (6–24 mon hs) is a ulne able phase, o en cha ac e ized by
poo die a y di e si y and malnu i ion (Pincho e al.,2021). S udies indica e ha many
child en in LMICs ecei e s a ch-hea y die s wi h limi ed p o ein and mic onu ien in akes,
leading o s un ing, ma asmus, and kwashio ko (M. M. Black e al.,2017). Add essing ood
secu i y, ma e nal educa ion, and nu i ion-sensi i e in e en ions a e c i ical o imp o ed
heal h ou comes (GNR,2020).
Vaccina ion emains one o he mos cos -e ec i e public heal h in e en ions. Ac-
co ding o he WHO (2021), immuniza ion p e en s 2–3 million child dea hs annually.
Expanding access o accines agains pneumonia, dia hea, and measles could signi ican ly
educe child mo ali y a es (Ma u a & A oakwah,2023). Addi ionally, he ea ly diagnosis
and ea men o childhood illnesses, such as pneumonia and gas oen e i is, a e c ucial in
educing unde - i e mo ali y (Ma u a & A oakwah,2023).
Howe e , he a ailable s udies we e limi ed in scope, wi h none ocused on child en
aged 2 yea s and below. The e o e, ou s udy will ocus on he impac o in es ing in he
i s 1000 days o li e on he heal h ou comes o child en unde he age o 5 yea s and, by
ex ension, on human capi al de elopmen .
3. Me hodology
This sec ion p o ides a summa y o he heo e ical amewo k adop ed, he esea ch
design used, he da a ype and sou ce, and he de ini ion and measu emen o he a iables
pe aining o child en unde wo yea s old, ocusing on hei demog aphics, heal h, and
nu i ion in he household.
3.1. Resea ch Design
A quan i a i e esea ch design was employed o in es iga e he ela ionship be ween
in es men in he i s 1000 days o li e and child heal h ou comes in Kenya. This in ol ed
a e iew o he li e a u e and desc ip i e s a is ics on basic child needs, including ma e nal
and child heal hca e, exclusi e b eas eeding, immuniza ion, and he ea men o common
childhood illnesses. This s udy assessed he ela ionship be ween access o hese basic
se ices and child mo ali y.
3.2. S udy Da a
This s udy used da a om he 2015/16 Kenya In eg a ed Household Budge Su ey
(KIHBS), co e ing 24,000 households ac oss Kenya. The da a ele an o child en unde wo
yea s we e ex ac ed, esul ing in a sample size o 12,630 obse a ions o aid in examining
demog aphics, heal h, and nu i ion h ough household da a.
Economies 2025,13, 105 6 o 22
3.3. Empi ical Model
This s udy employed he Cox P opo ional Haza ds model o e alua e he impac
o access o basic heal h se ices on in an and child mo ali y a es in Kenya. This semi-
pa ame ic eg ession model, es ablished by Cox (1972), is widely u ilized in medical
esea ch o analyze he ela ionship be ween su i al ime and p edic o a iables.
The Cox model is app op ia e o his esea ch as i accommoda es bo h quan i a i e
and ca ego ical p edic o a iables, allowing o he assessmen o mul iple isk ac o s
simul aneously. The model is semi-pa ame ic in na u e and allows o analysis wi hou
assuming a speci ic dis ibu ion o su i al imes, making i lexible and obus o eal-
wo ld da a. Fu he , he model allows o he inclusion o mul iple co a ia es, enabling his
s udy o assess ac o s such as b eas eeding, ma e nal educa ion, and heal hca e access on
child mo ali y. The model p o ides haza d a ios (HRs), o e ing in ui i e in e p e a ions
o s udy. I also assumes p opo ional haza ds, allowing o s able isk es ima ions o e
ime. I s applicabili y o bo h la ge and small da ase s makes i use ul in his con ex . The
model is exp essed ma hema ically as ollows:
h( )=h0( )∗expb1x1+b2, . . . , +bpxp(1)
whe e
h( )
is he haza d unc ion,
h0( )
is he baseline haza d, and b
1
,
b2. . .
, and
bp
a e
he es ima ed coe icien s indica ing he e ec sizes o he co a ia es. Haza d a ios (HRs),
de ined as exp(b
i
), p o ide insigh s in o he ela ionship be ween he co a ia es and he
isk o dea h.
The in e p e a ion o he HR alues is as ollows:
•HR = 1: no e ec .
•HR < 1: educed haza d.
•HR > 1: inc eased haza d.
The model aims o es ima e he mul i a ia e Cox eg ession as ollows:
h( )=h0( )∗expb1x1+b2x2+. . . +bpxp(2)
The ela i e isk o dea h will be es ima ed by
hi( i;xi)
h0( i)=expbixi(3)
The decision ules a e based on he HR ela i e o he compa ison g oup (coun ies).
The model assumes ha egula clinical in e en ions, such as an ena al and pos na al
ca e isi s, ake p ecedence o e ma e nal medical condi ions, a ec ing he p obabili y o
child mo ali y.
The dependen a iable, childhood mo ali y, is analyzed in wo age in e als:
1. In an mo ali y (bi h o 12 mon hs).
2. Child mo ali y (12 mon hs o 5 yea s).
The independen a iables include he ollowing:
i.
Ma e nal and child heal hca e indica o s (e.g., he place o bi h, assis ed deli e y,
an ena al ca e isi s).
ii. Basic heal hca e inpu s (e.g., exclusi e b eas eeding, immuniza ion).
iii. Nu i ion- ela ed ou comes (e.g., s un ing, was ing, being unde weigh ).
i . Heal h mo bidi y ac o s (e.g., ma e nal mo bidi y, ges a ional diabe es).
The dependen a iables comp ise he ollowing:
i. In an mo ali y: he p obabili y o dying be ween bi h and he i s bi hday.
Economies 2025,13, 105 7 o 22
ii. Child mo ali y: he p obabili y o dying be ween ages one and i e.
iii.
Child mo bidi y: he p obabili y o a child expe iencing dia hea om bi h o age wo.
The analysis ocuses on households wi h child en bo n ali e bu who died wi hin he
pe iod 2015–2016. The KIHBS 2015–2016 da a we e u ilized o assess mo ali y a es ac oss
he speci ied age g oups. The STATA so wa e ( e sion 18) acili a ed he es ima ion o he
coe icien s and he haza d a ios, wi h he indi idual le el as he uni o analysis. The
esul s we e p esen ed using app op ia e ables and igu es.
Addi ionally, his s udy employed a P obi eg ession model o examine he de e mi-
nan s o child mo bidi y, ocusing on he p obabili y o child en aged 0 o 2 yea s alling
sick om dia hea. The P obi model is app op ia e o es ima ing bina y dependen a i-
ables, as i assumes a no mal dis ibu ion o he e o e m, allowing o a mo e accu a e
ep esen a ion o he p obabili y o illness occu ence.
The empi ical model speci ica ion is p esen ed below, whe e he p obabili y ha a
child,
i
, expe iences dia hea (
Yi
= 1) is modeled as a unc ion o a ious socioeconomic,
en i onmen al, and heal h- ela ed ac o s. The P obi model is exp essed as ollows:
P(Yi=1/Xi)=∅(Xiβ+εi)(4)
whe e he
•P(Yi=1/XI) ep esen s he p obabili y ha child isu e s om dia hea.
•∅
is he cumula i e dis ibu ion unc ion o he s anda d no mal dis ibu ion, ensu ing
ha he es ima ed p obabili ies lie be ween 0 and 1.
•Xiis a ec o o explana o y a iables in luencing child mo bidi y.
•β ep esen s he coe icien s o be es ima ed.
•εiis he no mally dis ibu ed e o e m.
This empi ical app oach allows o a quan i a i e assessmen o key ac o s in luencing
child mo bidi y, in o ming a ge ed in e en ions o educe childhood dia hea in Kenya.
3.4. Va iables and Measu emen
Households we e deemed o ha e access o basic needs and se ices i hey had access
o key ma e nal and child heal h indica o s, as indica ed by he p edic o alues below.
The dependen a iables included in an mo ali y (dea hs om bi h o 12 mon hs), child
mo ali y (dea hs om 12 mon hs o 60 mon hs), and child mo bidi y (dia hea incidence).
The p edic o a iables included indica o s ela ed o ma e nal heal hca e, such as he
place o bi h, assis ed deli e y, he numbe o an ena al ca e isi s, and household income,
and child heal h indica o s, such as exclusi e b eas eeding, immuniza ion, and ma e nal
pa icipa ion in communi y nu i ion p og ams.
3.5. Da a Sou ces
The main sou ce o da a was he Kenya In eg a ed Household Budge Su ey (KI-
HBS) 2015–2016, conduc ed by he Kenya Na ional Bu eau o S a is ics (KNBS), which
p o ided comp ehensi e in o ma ion on heal h, educa ion, and socioeconomic indica o s
o households wi h child en unde i e yea s old. These da a we e essen ial o analyzing
he de e minan s o child heal h and mo ali y ac oss a ious households.
4. Resul s
This sec ion highligh s he desc ip i e s a is ics esul s, including he esul s on he
s a us o he main needs o child en and households wi h child en in Kenya. In addi ion, i
p esen s he esul s on he access o c i ical se ices on child en heal h mo ali y ou comes
in Kenya, and las ly, i p esen s a discussion on he empi ical esul s
Economies 2025,13, 105 8 o 22
4.1. Desc ip i e S a is ics
This s udy u ilized he KIHBS 2015/16 da ase , which included 92,846 indi iduals, o
whom, 16.71% (15,560) we e unde 5 yea s old. Among hese, 81.56% (12,690) we e aged
less han 1 yea . Table 1summa izes he age dis ibu ion o hese child en.
Table 1. A e age age o child en in mon hs.
Age in Mon hs F equency Pe cen
0 1573 12.4
1 1067 8.41
2 1110 8.75
3 1061 8.36
4 1042 8.21
5 1035 8.16
6 1082 8.53
7 1020 8.04
8 960 7.57
9 954 7.52
10 905 7.13
11 881 6.94
12,690 100
Sou ce o da a: KIHBS, 2015/16.
Table 2shows ha app oxima ely 14% o child en we e unde weigh , wi h highe
a es in u al a eas. The -s a is ic (5.31 ***) sugges s ha his di e ence is s a is ically
signi ican a he 1% le el, meaning he e is a e y low p obabili y ha his di e ence
occu ed by chance. S un ing a ec ed abou 28% o child en, wi h u al a eas again being
mos a ec ed. The -s a is ic (12.95 ***) con i ms ha his di e ence is highly signi ican ,
indica ing ha child en in u al a eas a e mo e likely o expe ience ch onic malnu i ion
and s un ed g ow h, possibly due o poo e nu i ion and limi ed access o heal hca e.
Abou 9% o child en expe ienced was ing, which was also highe in u al a eas. This is
a ibu ed o he inc eased eliance on s aple ood like maize wi h a limi ed consump ion o
p o eins and ege ables and a lack o die a y di e si y in u al a eas, as compa ed o u ban
a eas. The a e age household size was six, being signi ican ly la ge in u al compa ed o
u ban a eas. The a e age age o child en was 5 mon hs. The -s a is ic (
−
0.07) shows no
s a is ically signi ican di e ence, con i ming ha he sample is e enly dis ibu ed in e ms
o child age ac oss u al and u ban se ings.
App oxima ely 8% o he esponden s epo ed dia hea in he las wo weeks p io o
he su ey in 2015/16, which is almos in ange wi h he KDHS 2022, which es ima ed he
dia hea p e alence a 14%. Child mo ali y a ied, wi h signi ican di e ences be ween
u ban and u al a eas. Mos mo he s (61%) deli e ed in heal h acili ies, wi h highe a es
in u ban a eas (81% s. 52% u al). Abou 64% o mo he s who deli e ed in heal h acili ies
we e assis ed by heal h p o essionals, wi h u ban mo he s ha ing be e access (83% s. 55%
u al). This e lec s be e access o heal hca e acili ies in he u ban a eas, as compa ed o
u al a eas, whe e pa ien s ha e o a el longe dis ances o ge o he heal hca e acili ies.
Also, he e is p e e ence o homebi hs in u al a eas, as compa ed o u ban a eas. Nea ly
90% o mo he s exclusi ely b eas ed o 6 mon hs, wi h a highe pe cen age in u al a eas.
Howe e , 39% supplemen ed b eas eeding wi h milk o he han b eas milk. Pa icipa ion
in communi y nu i ion p og ams was simila in u al and u ban a eas (abou 31%).
Economies 2025,13, 105 15 o 22
Table 11. Con .
Va iable Coe icien
Robus S d E o
P > |Z|
SEKEB 0.0877 0.0800 0.273
NAKAEB 0.0805 0.0835 0.335
NAIROBI 0.1786 0.1313 0.174
Cons an −0.6535 0.1219 0.000
Obse a ion = 11,938
Wald chi2(21) = 279.390
P ob > chi2= 0.0000
Pseudo R2 = 0.0438
Log pseudo likelihood = 3212.2238
AIC = 6464.448
BIC = 6612.197
Sou ce o da a: esea che ’s compu a ion.
Access o bi h assis ance posi i ely a ec s child nu i ion and signi ican ly educes he
isk o dia hea by educing he isk o neona al in ec ions. The household size signi ican ly
educes he p obabili y o a child unde i e epo ing dia hea (Table 12). P e ious s udies
indica e ha a la ge household size is posi i ely co ela ed wi h a highe incidence o
dia hea. Ou indings sugges he opposi e, which may be a ibu ed o he inc eased
supe ision o younge child en by mo e household membe s.
Table 12. The maximum likelihood es ima es o P obi model on he d i e s o dia hea p e alence
among child en unde 5 yea s o age (child mo bidi y) in Kenya.
Va iable dydx Del a Me hod- S d E o P > |Z|
Access o wa e (1 = imp o ed) −0.0070 *** 0.0053 0.189
Access o sani a ion (1 = imp o ed) −0.0016 *** 0.0076 0.831
Access o hygiene (1 = imp o ed) −0.0136 *** 0.0082 0.095
Age (yea s) −0.0220 *** 0.0019 0.000
Gende (1 = male) −0.0083 *** 0.0049 0.091
Household size (numbe ) −0.0038 *** 0.0012 0.002
Household asse s (1 = yes) −0.0104 *** 0.0101 0.303
Household being absolu ely poo (1 = yes) 0.0007 *** 0.0056 0.897
Bi h assis ance (1 = heal h p o essional) −0.0257 *** 0.0118 0.030
Place o deli e y (1 = heal h acili y) −0.0277 *** 0.0116 0.017
Child supplemen s (1 = milk o he han b eas )
0.0023 *** 0.0055 0.671
Residence (1 = u al) −0.0055 *** 0.0057 0.331
Regional Bloc (NOREB = base ca ego y)
LREB 0.0086 *** 0.0076 0.257
PWANI 0.0426 *** 0.0101 0.000
CEKEB 0.0020 *** 0.0090 0.823
FCDC −0.0455 *** 0.0072 0.000
Economies 2025,13, 105 16 o 22
Table 12. Con .
Va iable dydx Del a Me hod- S d E o P > |Z|
SEKEB 0.0131 *** 0.0124 0.288
NAKAEB 0.0120 *** 0.0129 0.350
NAIROBI 0.0284 *** 0.0229 0.215
Cons an −0.6581 0.1161 0.000
Obse a ion = 11,938
Wald chi2(21) = 279.390
P ob > chi2= 0.0000
Pseudo R2 = 0.0438
Log pseudo likelihood = 3212.2238
No es.
1
Sou ce o da a: esea che ’s compu a ion. No e: as e isks (*) indica e he le el o s a is ical signi icance
*** (p< 0.001).
The place o deli e y signi ican ly impac s dia hea p e alence, as deli e ing in heal h
acili ies educes he p obabili y o dia hea- ela ed mo ali y in child en unde i e by
2.7%. This inding aligns wi h Bi ew e al. (2023), indica ing hygiene is c ucial in p e en ing
childhood dia hea. Con e sely, he lack o skilled bi h assis ance inc eases he isk o
dia hea, sugges ing unsupe ised deli e ies lead o poo e hygiene p ac ices and g ea e
ulne abili y o in ec ions.
Using NOREB as he base ca ego y, he spa ial assessmen indica ed ha child en in
a ious economic blocs, especially Jumuia ya Kaun i za Pwani, Nai obi, and SEKEB, expe i-
ence a highe dia hea incidence han hose in NOREB. In con as , he FCDC demons a ed
educed dia hea incidences, possibly due o a ying le els o wa e con amina ion and
sani a ion p ac ices.
5.2. Cox P opo ional Haza d Reg ession on D i e s o Child Mo ali y
The Cox p opo ional haza d eg ession analysis using he B eslow me hod e ealed a
s ong i wi h signi ican Wald chi
2
(20), o 295.26, and P ob > chi
2
(0.0000). Table 13 shows
he Cox p opo ional haza d eg ession esul s, which indica e ha s un ing, was ing, an
unde weigh s a us, he a ea o esidence, child supplemen a ion, exclusi e b eas eeding,
and ma e nal pa icipa ion in communi y nu i ion p og ams signi ican ly a ec child
su i al a es.
This s udy ound ha supplemen a ion wi h milk o he han b eas milk had an
ad e se e ec on he child mo ali y haza d isk. Speci ically, mo he s who supplemen ed
hei child en educed he isk o child mo ali y by 7.3% compa ed o hose who did no use
any supplemen s. This sugges s ha al e na i e milk sou ces can p o ide essen ial nu ien s
ha con ibu e o child su i al, pa icula ly in cases whe e exclusi e b eas eeding may
no be easible due o ma e nal heal h issues, insu icien b eas milk p oduc ion, o o he
socioeconomic ac o s. Howe e , his inding does no con adic he well-es ablished
bene i s o exclusi e b eas eeding. A he same ime, his s udy con i med ha exclusi e
b eas eeding signi ican ly educes he child mo ali y isk. An inc ease in he exclusi e
b eas eeding du a ion co ela ed wi h a 1.4 imes lowe isk o child mo ali y compa ed o
child en who we e ne e b eas ed. This aligns wi h p e ious esea ch (Rahman,2008) ha
demons a ed how p olonged exclusi e b eas eeding enhances in an immuni y, p e en s
in ec ions, and imp o es o e all su i al a es.
Economies 2025,13, 105 17 o 22
Table 13. The Cox p opo ional haza d eg ession on he d i e s o child mo ali y ( he p obabili y o
a child dying be ween bi h and he i s yea ).
Va iables Haza d Ra io (Robus S d E o ) Rela i e Haza d Ra io dy/dx
(Del a-Me hod S d E o )
Access o wa e (% imp o ed) 1.0006 (0.0185) 0.0005 (0.0159)
Access o sani a ion (% imp o ed) 0.9307 (0.0244) *** −0.0615 (0.0215) ***
Access o hygiene (1 = imp o ed) 1.0317 (0.0282) 0.0267 (0.0234)
Household size (numbe ) 0.9866 (0.0041) *** −0.0116 (0.0035) ***
Age (yea s) 1.0197 (0.0068) *** 0.0167 (0.0060) ***
Gende (1 = male) 0.9975 (0.0169) −0.0021 (0.0145)
Household asse s 1.0011 (0.0311) 0.0010 (0.0266)
Numbe o bi hs (numbe ) 1.0178 (0.0063) 0.0167 (0.0061)
Exclusi ely b eas eeding 0.6710 (0.0931) *** −0.0518 (0.0318) ***
Child supplemen s (1 = milk o he
han b eas ) 1.0137 (0.0185) 0.0126 (0.0187)
Bi h assis ance (1 = heal h p o essional) 0.7881 (0.1072) *** −0.0260 (0.0611)
Place o deli e y (1 = heal h acili y) 0.6774 (0.0630) *** −0.0165 (0.0368)
Residence (1 = u al) 1.1053 (0.0865) *** 0.0603 (0.0428) ***
Age o mo he (yea s) 1.0231 (0.0091) 0.0220 (0.0083)
Ma e nal educa ion (1 = seconda y school)
0.7943 (0.1048) *** −0.0629 (0.0608) ***
Ma e nal pa icipa ion in communi y
p og am 0.6418 (0.0962) *** −0.0512 (0.0272) ***
S un ing (1 = yes) 1.7166 (0.1902) *** 0.1984 (0.0545) ***
Was ing (1 = yes) 1.2135 (0.2118) 0.1837 (0.0890)
Unde weigh (1 = yes) 1.3503 (0.2471) *** 0.1568 (0.0852) ***
Numbe o obse a ions: 6774; numbe o e en s: 474; Wald chi
2
(15) = 158.850; P ob > chi
2
= 0.0000. Sou ce o
da a: esea che ’s compu a ion. No e: as e isks (*) indica e he le el o s a is ical signi icance *** (p< 0.001).
Fu he mo e, he a ea o esidence signi ican ly in luenced he child mo ali y isk.
This s udy ound ha mo he s li ing in u ban a eas had a 3.5% lowe likelihood o expe i-
encing child mo ali y haza ds compa ed o hose in u al a eas. This suppo s Ayele e al.
(2017), who iden i ied u ban– u al dispa i ies in child mo ali y due o be e heal hca e
access, imp o ed sani a ion, and highe ma e nal educa ion le els in u ban se ings.
This s udy also conside ed he p obabili y o a child dying be ween bi h and
12 mon hs o age. Using he STCox p opo ional haza ds model, his s udy ound
a weak signi ican ela ionship be ween nu i ional ac o s (p opo ions o s un ed,
was ed, and unde weigh child en) and in an mo ali y (dea hs be ween bi h and
12 mon hs o age) (Table 14). This sugges s ha he e ec s o poo nu i ion may
mani es mo e signi ican ly la e in a child’s li e. Addi ionally, bo h he household
size and inancial s a us we e posi i ely co ela ed wi h in an mo ali y a es. La ge
household sizes and poo e inancial condi ions we e associa ed wi h an inc eased
likelihood o child en dying be o e eaching hei i s bi hday. This is likely linked o
challenges in accessing heal hca e se ices due o inancial cons ain s and compe ing
needs a ising om la ge amilies.
Economies 2025,13, 105 18 o 22
Table 14. P obabili y o a child dying be ween bi h and 12 mon hs o age (in an mo ali y).
Va iables Coe icien s wi h S d
E o s in Pa en heses pValues
Access o wa e (% imp o ed) 1.0000 (0.0182) 0.998
Access o sani a ion (% imp o ed) 0.9346 (0.0241) *** 0.001
Access o hygiene (1 = imp o ed) 1.0253 (0.0275) 0.351
Household size (numbe ) 0.9859 (0.0040) *** 0.000
Age (yea s) 1.0168 (0.0067) *** 0.011
Gende (1 = male) 1.0011 (0.0167) 0.949
Household asse s 0.9986 (0.0305) 0.962
Numbe o bi hs (numbe ) 1.0247 (0.0082) *** 0.002
Household being absolu ely poo (
1 = yes
)
1.0372 (0.0196) ** 0.053
Residence (1 = u al) 0.9817 (0.0193) 0.347
Dia hea incidence (1 = yes) 0.9974 (0.0297) 0.930
Place o child deli e y (1 = heal h acili y) 0.9597 (0.0376) 0.0293
Bi h assis ance (% heal h p o essional) 1.0253 (0.0404) 0.526
Child supplemen s (1 = milk o he
han b eas ) 0.9293 (0.0173) *** 0.000
Child exclusi ely b eas eeding (1 = 0 o
6 mon hs) 1.0016 (0.0301) 0.957
Obse a ion 10,550
Wald chi2(20) 204.040
P ob > chi20.0000
Log pseudo likelihood −89,059.797
Failu e_-d Age in mon hs
Analysis ime— Age in mon hs
Numbe o subjec s 10,550
Numbe o ailu es 10,550
Time a isk 61,259
Sou ce o da a: esea che ’s compu a ion. No e: as e isks (*) indica e he le el o s a is ical signi icance
** (p< 0.01
),
and *** (p< 0.001).
5.3. Conclusions and Implica ions o Policy
This s udy iden i ied se e al key ac o s in luencing child heal h in Kenya, pa icula ly
ocusing on he p e alence o dia hea and child mo ali y among child en unde i e. The
indings e ealed ha la ge household sizes signi ican ly educe he likelihood o dia hea,
while nu i ional ac o s, such as being unde weigh , s un ing, and was ing, a e c i ical
con ibu o s o child mo ali y isks. The o e all p e alence o dia hea in child en unde
i e in Kenya was epo ed a 8%, sligh ly below he global a e age o 9%. Access o im-
p o ed wa e , sani a ion, hygiene, household asse s, and skilled bi h assis ance posi i ely
a ec s child nu i ion and heal h ou comes. This s udy highligh s he impo ance o in-
es men in he i s 1000 days o li e, pa icula ly h ough ma e nal heal hca e, imp o ing
access o wa e and sani a ion, and imp o ing in an eeding p ac ices. Consequen ly, his
s udy s ongly ad oca es o a ge ed in e en ion p og ams aimed a educing childhood
dia hea and imp o ing child heal hca e and nu i ion.
Economies 2025,13, 105 19 o 22
5.3.1. Policy Recommenda ions
1.
This s udy ecommends enhancing communi y unde s anding ega ding he signi i-
cance o a ending an ena al heal hca e isi s and op ing o deli e ies a heal hca e
acili ies, a he han a home. This can be achie ed by aining and equipping Com-
muni y Heal h P omo e s and wo ke s o iden i y and suppo expec an mo he s and
ensu ing ea ly hospi al linkages and pos na al ollow-ups.
2.
The indings indica e he need o in e en ion p og ams ha a e ocused on p e-
en ing childhood dia hea and p omo ing be e nu i ion. The go e nmen , p i a e
sec o , and ci il socie y should collabo a e o expand he WASH in as uc u e in bo h
u al and u ban a eas.
3.
Fu he , he indings sugges he need o a legisla i e e iew. This s udy calls o
ac ion o he go e nmen o conduc imely e iews o legisla ion and policies o
enhance child nu i ion and heal hca e, pa icula ly ega ding in e en ions ela ed o
b eas eeding, nu i ional supplemen s, and educa ion o new mo he s.
4.
Ta ge ed heal h in e en ions should also be employed. The e is a need o guide na-
ional and coun y-le el heal h in e en ions o add ess highe child mo ali y haza d
isks, ensu ing ha esou ces and policies p io i ize a eas wi h he g ea es need.
5.3.2. Limi a ions o he S udy and Fu u e P ospec o Resea ch
Despi e p o iding aluable insigh s in o he signi icance o in es ing in he i s
1000 days o li e o imp o ed child heal h ou comes, his s udy has ce ain limi a ions ha
should be conside ed when in e p e ing i s indings.
1.
Da a cons ain s we e he main challenge. This s udy elied on seconda y da a
om he Kenya In eg a ed Household Budge Su ey (KIHBS) 2015/16 and Kenya
Demog aphic and Heal h Su ey (KDHS). The KIHBS 2015/16 da a we e he mos
ecen da a a he ime o he s udy. The use o c oss-sec ional da a limi s he abili y o
es ablish causal ela ionships o e ime. A longi udinal s udy would p o ide a mo e
comp ehensi e unde s anding o he long- e m e ec s o ea ly childhood in es men s.
2.
Geog aphical and socioeconomic a iabili y also cons ain s he indings o he s udy:
he s udy ecognizes egional dispa i ies in child heal h ou comes bu does no comp e-
hensi ely analyze he ole o speci ic cul u al, economic, and en i onmen al ac o s
ac oss di e en coun ies. A mo e de ailed coun y-le el analysis could help ailo
in e en ions o speci ic local con ex s.
3.
The exclusion o ce ain heal h de e minan s was ano he ac o : while he s udy
ocuses on key indica o s such as ma e nal heal hca e, exclusi e b eas eeding, and
immuniza ion, i does no ex ensi ely co e o he de e minan s like pa en al edu-
ca ion, household income dynamics, and access o heal hca e in as uc u e, which
could signi ican ly impac child heal h ou comes.
5.3.3. Fu u e P ospec s
To add ess hese limi a ions and enhance esea ch in his a ea, u u e s udies should
a.
Inco po a e longi udinal da a: conduc ing longi udinal s udies would p o ide deepe
insigh s in o how in es men s in he i s 1000 days impac long- e m heal h and
human capi al de elopmen ou comes.
b.
Expand he scope o analysis: u u e esea ch should explo e he in luence o socioe-
conomic ac o s, gende dispa i ies, and communi y heal h p og ams on child heal h
and nu i ion ou comes.
c.
Le e age ad anced analy ical app oaches: using geospa ial and econome ic model-
ing can help iden i y high- isk egions and ailo a ge ed in e en ions.
Economies 2025,13, 105 20 o 22
6. Conclusions
In conclusion, hese indings emphasize he c i ical ole o imp o ing wa e and
sani a ion access, enhancing ma e nal educa ion, and add essing malnu i ion in educing
child mo bidi y and mo ali y in Kenya. Addi ionally, his s udy p o ides he measu es
necessa y o suppo he go e nmen e o o educing child mo ali y a es and enhancing
he o e all heal h o child en in Kenya.
Au ho Con ibu ions: Concep ualiza ion, L.K.O. and H.N.; me hodology, H.N.; so wa e, H.N.;
alida ion, L.K.O. and H.N.; o mal analysis, H.N.; in es iga ion, H.N.; esou ces, L.K.O. and
H.N.; da a cu a ion, H.N.; w i ing—o iginal d a p epa a ion, L.K.O. and H.N.; w i ing— e iew
and edi ing, L.K.O. and H.N.; isualiza ion, L.K.O.; supe ision, L.K.O.; p ojec adminis a ion,
L.K.O.; unding acquisi ion, L.K.O. All au ho s ha e ead and ag eed o he published e sion o he
manusc ip .
Funding: This esea ch was unded by A ican Economic Resea ch Conso ium g an numbe
AERC: RC21614.
Da a A ailabili y S a emen : This s udy u ilized da a om he Kenya In eg a ed Household Budge
Su ey (KIHBS), conduc ed by he Kenya Na ional Bu eau o S a is ics (KNBS). The KIHBS da a a e
publicly a ailable o esea ch pu poses upon eques om he Kenya Na ional Bu eau o S a is ics
(KNBS) h ough hei o icial websi e (www.knbs.o .ke accessed on 1 June 2023) o by con ac ing
KNBS di ec ly. Access o he da ase is subjec o he e ms and condi ions ou lined by KNBS,
including compliance wi h da a con iden iali y and usage policies.
Con lic s o In e es : The au ho s decla e no con lic o in e es .
No e
1
No es: The Cen al Region Economic Bloc (CEREB) comp ises en coun ies, namely, Embu, Kiambu, Ki inyaga, Laikipia,
Me u, Mu ang’a, Naku u, Nyanda ua, Nye i, and Tha aka Ni hi.Sou h Eas e n Kenya Economic Bloc (SEKEB) comp ises
Makueni, Machakos, and Ki ui.Na ok-Kajiado Economic Bloc (NAKAEB) comp ises he Na ok and Kajiado coun ies.Jumuia
ya Kaun i za Pwani comp ises he Tana Ri e , Tai a Ta e a, Lamu, Kili i, Kwale, and Mombasa coun ies.Lake Region
Economic Bloc (LREB) comp ises he Migo i, Nyami a, Siaya, Vihiga, Bome , Bungoma, Busia, Homa Bay, Kakamega,
Kisii, Kisumu, and Ke icho coun ies.No h Ri Economic Bloc (NOREB) comp ises Uasin Gishu, T ans-Nzoia, Nandi,
Elgeyo-Ma akwe , Wes Poko , Ba ingo, Sambu u, and Tu kana.F on ie Coun ies De elopmen Council (FCDC) comp ises
Ga issa, Waji , Mande a, Isiolo, and Ma sabi .
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Disclaime /Publishe ’s No e: The s a emen s, opinions and da a con ained in all publica ions a e solely hose o he indi idual
au ho (s) and con ibu o (s) and no o MDPI and/o he edi o (s). MDPI and/o he edi o (s) disclaim esponsibili y o any inju y o
people o p ope y esul ing om any ideas, me hods, ins uc ions o p oduc s e e ed o in he con en .
