Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan;7(1):e007544.
doi: 10.1136/bmjgh-2021-007544.

A growing disadvantage of being born in an urban area? Analysing urban-rural disparities in neonatal mortality in 21 African countries with a focus on Tanzania

Megan Norris  1 , Gonnie Klabbers  1 , Andrea B Pembe  2 , Claudia Hanson  3   4 , Ulrika Baker  5 , Kyaw Aung  5 , Mary Mmweteni  5 , Rashid S Mfaume  6 , Lenka Beňová  7
Affiliations

A growing disadvantage of being born in an urban area? Analysing urban-rural disparities in neonatal mortality in 21 African countries with a focus on Tanzania

Megan Norris et al. BMJ Glob Health. 2022 Jan.

Abstract

Introduction: Neonatal mortality rate (NMR) has been declining in sub-Saharan African (SSA) countries, where historically rural areas had higher NMR compared with urban. The 2015-2016 Demographic and Health Survey (DHS) in Tanzania showed an exacerbation of an existing pattern with significantly higher NMR in urban areas. The objective of this study is to understand this disparity in SSA countries and examine the specific factors potentially underlying this association in Tanzania.

Methods: We assessed urban-rural NMR disparities among 21 SSA countries with four or more DHS, at least one of which was before 2000, using the DHS StatCompiler. For Tanzania DHS 2015-2016, descriptive statistics were carried out disaggregated by urban and rural areas, followed by bivariate and multivariable logistic regression modelling the association between urban/rural residence and neonatal mortality, adjusting for other risk factors.

Results: Among 21 countries analysed, Tanzania was the only SSA country where urban NMR (38 per 1000 live births) was significantly higher than rural (20 per 1,000), with largest difference during first week of life. We analysed NMR on the 2015-2016 Tanzania DHS, including live births to 9736 women aged between 15 and 49 years. Several factors were significantly associated with higher NMR, including multiplicity of pregnancy, being the first child, higher maternal education, and male child sex. However, their inclusion did not attenuate the effect of urban-rural differences in NMR. In multivariable models, urban residence remained associated with double the odds of neonatal mortality compared with rural.

Conclusion: There is an urgent need to understand the role of quality of facility-based care, including role of infections, and health-seeking behaviour in case of neonatal illness at home. However, additional factors might also be implicated and higher NMR within urban areas of Tanzania may signal a shift in the pattern of neonatal mortality across several other SSA countries.

Keywords: cross-sectional survey; maternal health; paediatrics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Time trends in neonatal mortality rate (per 1000 live births) from the Tanzania Demographic and Health Survey (DHS), by year of DHS.
See this image and copyright information in PMC

References

    1. United Nations Inter-agency Group for Child Mortality Estimation UI . Levels & Trends in Child Mortality Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. New York: United Nation’s Children’s Fund, 2019.
    1. Hug L, Alexander M, You D, et al. . National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health 2019;7:e710–20. 10.1016/S2214-109X(19)30163-9 - DOI - PMC - PubMed
    1. World Health Organisation . Neonatal mortality rate (per 1 000 live births). Geneva: World Health Organisation, Geneva, 2006.
    1. Oestergaard MZ, Inoue M, Yoshida S, et al. . Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med 2011;8:e1001080. 10.1371/journal.pmed.1001080 - DOI - PMC - PubMed
    1. United Nations Inter-agency Group for Child Mortality Estimation UI . Levels & Trends in Child Mortality Estimates developed by the UN Inter-agency Group for Child Mortality Estimation, 2018. - PMC - PubMed

Publication types