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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

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 hig...

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Autores principales: Norris, Megan, Klabbers, Gonnie, Pembe, Andrea B, Hanson, Claudia, Baker, Ulrika, Aung, Kyaw, Mmweteni, Mary, Mfaume, Rashid S, Beňová, Lenka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8728407/
https://www.ncbi.nlm.nih.gov/pubmed/34983787
http://dx.doi.org/10.1136/bmjgh-2021-007544
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author Norris, Megan
Klabbers, Gonnie
Pembe, Andrea B
Hanson, Claudia
Baker, Ulrika
Aung, Kyaw
Mmweteni, Mary
Mfaume, Rashid S
Beňová, Lenka
author_facet Norris, Megan
Klabbers, Gonnie
Pembe, Andrea B
Hanson, Claudia
Baker, Ulrika
Aung, Kyaw
Mmweteni, Mary
Mfaume, Rashid S
Beňová, Lenka
author_sort Norris, Megan
collection PubMed
description 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.
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spelling pubmed-87284072022-01-18 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 Norris, Megan Klabbers, Gonnie Pembe, Andrea B Hanson, Claudia Baker, Ulrika Aung, Kyaw Mmweteni, Mary Mfaume, Rashid S Beňová, Lenka BMJ Glob Health Original Research 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. BMJ Publishing Group 2022-01-04 /pmc/articles/PMC8728407/ /pubmed/34983787 http://dx.doi.org/10.1136/bmjgh-2021-007544 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Norris, Megan
Klabbers, Gonnie
Pembe, Andrea B
Hanson, Claudia
Baker, Ulrika
Aung, Kyaw
Mmweteni, Mary
Mfaume, Rashid S
Beňová, Lenka
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8728407/
https://www.ncbi.nlm.nih.gov/pubmed/34983787
http://dx.doi.org/10.1136/bmjgh-2021-007544
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