Robert BN, Macharia PM, Lessani MN, Chepkurui V, Kamau J, Snow RW, Li Z, Okiro EA
Spat Spatiotemporal Epidemiol. 2025;55
BACKGROUND: Everyone deserves legal recognition, yet millions of children remain unregistered, with the majority (87%) residing in sub-Saharan Africa and southern Asia. Despite global efforts to improve birth registration coverage, sub-national disparities persist. Across Kenya's 47 counties, birth registration completeness rates varies from nearly 100% to as low as 12.2%, suggesting local contextual factors are important. This study explores the influence of contextual factors on the spatially heterogeneous rates of birth registration in Kenya. METHODS: We utilized data from the 2022 Kenya Demographic and Health Survey. The association between registered births and its determinants (child factors, health care indicators, maternal, household and geographical factors) was assessed at the cluster level (villages) using four regression models: ordinary least square (OLS) and spatial local regression using Geographically Weighted Regression (GWR-single spatial scale for all predictors), Multiscale GWR (MGWR-each predictor operates at different spatial scale) and Similarity GWR (SGWR-single spatial scale for all predictors) models. Best-fit models were assessed using adjusted R(2), AICc and Moran's I (residual spatial autocorrelation). The key difference between GWR and SGWR lies in how spatial dependency is measured between locations. RESULTS: A total of 1673 survey clusters were analysed. MGWR was the best-fitting model (AICc = 14,870.57, adjusted R(2) = 0.40, Moran's I = -0.04 (p-value = 0.999)) and identified localised significant relationships for all variables examined. Evidence of spatially varying relationship (local influence) was observed between birth registration, bank account ownership, and unemployment. Regional influence was observed for female-headed households, while other associations maintained a uniform relationship across the study area (global influence). CONCLUSION: Determinants of birth registration vary spatially at different geographical scales, necessitating context-specific targeted strategies to boost registration coverage across diverse areas and populations.
