Prevalence and determinants of death registration across three demographic surveillance sites in Kenya

Abstract Background Death registration remains markedly incomplete in many low- and middle-income settings despite its importance in generating population statistics for health systems planning and monitoring of sustainable development goals. We assessed the completeness of death registration and its determinants across three Health and Demographic Surveillance System (HDSS) sites in Kenya. Methods We conducted household surveys at three HDSS sites: Nairobi, Kisumu, and Kilifi, where 1,363 households with a recent death in 2022 or 2023 were sampled. We quantified death registration completeness, evaluated determinants of death registration using random-effects regression analysis, and characterised reasons for registration and non-registration. Results Among 1,387 deaths, only 257 (18.5%) were reported by respondents as registered, with similarly low completeness in both rural and urban settings. Registration was lowest for deaths among infants (Adjusted Odds Ratio (AOR) 0.09; 95% CI 0.03–0.26; p < 0.001) and children 1–4 years (AOR 0.14; 95% CI 0.04–0.48; p = 0.002) compared with adults 65–84 years. It was lower among the deceased who were unmarried (AOR 0.38; 95% CI 0.17–0.84; p = 0.016), unemployed (AOR 0.60; 95% CI 0.40–0.89; p = 0.011), and those who died at home (AOR 0.65; 95% CI 0.47–0.90; p = 0.010). Deaths in urban settings were more likely to be registered (AOR 1.55; 95% CI 1.07–2.24; p = 0.020). There were higher odds of registration in households with greater wealth (AOR 2.50; 95% CI 1.52–4.11; p < 0.001), and among deceased who were employed or retired (AOR 1.87; 95% CI 1.27–2.74; p = 0.001). Recent deaths (0–6 months) were least likely to be registered (AOR 0.26; 95% CI 0.14–0.48; p = < 0.001). The most cited reason for registration was inheritance-related requirements. Lack of awareness, high costs and perceived lack of benefits were the leading reasons for non-registration. Conclusions Death registration in Kenya is low and delayed, with disadvantaged populations disproportionately excluded. Strengthening awareness and advocacy for timely registration, particularly of infant and under-five deaths, alongside targeted efforts to reach the poor and unemployed, is essential to promote social inclusion and advance health equity.