In Tanzania, infants born in cities surprisingly have an increased mortality rate in their first month of life compared to babies born in rural areas.
In 2019, for every 1,000 live births in Sub-Saharan Africa, 27 had a higher mortality rate within the first month of life, a rate that was ten times that of children born in high-income countries, according to the World Health Organisation (WHO).
Neonatal Mortality rate (NMR) has been declining in sub-Saharan African (SSA) countries, where historically rural areas had a 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 study’s objective was to understand this disparity in SSA countries and examine the specific factors potentially underlying this association in Tanzania.
The study published in BMJ Global Health showed that for everyone 1,000 infants born alive, 20 in rural Tanzania die in their first month of life compared to 38 in cities.
The neonatal mortality rate for infants
However, the researchers said that although historically the number of infants who die in their first month of life per 1,000 infants born alive (the neonatal mortality rate) has been higher in rural areas than in cities due to decreased access to healthcare in villages, the rural-urban differences in such deaths have been narrowing in present times.
“Even after excluding the effect of other explanatory factors (such as babies with low birth weight), we still saw that neonatal mortality rate in urban areas remained twice as much as that of rural areas,” said Lenka Beňová, a co-author of the study.
But Beňová, who is an associate professor of maternal and reproductive health at the Institute of Tropical Medicine in Antwerp, Belgium, told SciDev.Net that their findings do not show any concrete evidence of what might be causing the higher urban neonatal mortality rate. She said her research group was planning to conduct further studies.
“For example, we want to ensure we are measuring the urban versus rural residence of the mothers’ households very accurately, and that we consider the effect of mixing up neonatal deaths and stillbirths,” Beňová added.
The study involved the analysis of disparities in infant mortality rate using demographic and health surveys of 21 countries in Sub-Saharan Africa. For Tanzania, the researchers analysed the 2015-2016 data to determine the association between residing in urban or rural areas and neonatal mortality rate after adjusting for risk factors including characteristics of the households, low birth weight, and the environment into which infants were born.
Of the 21 countries, only Tanzania had infant mortality rates in cities that were significantly more than of rural areas, the study found.
Beňová said that the findings should alert national and local authorities to the fact that preventable neonatal death should be a big concern even in areas with higher accessibility of health care such as cities, and that there is the need for quality care for pregnant women and new-born babies.
Urban infants at higher risk of death
According to the study, the issue of urban infants being at higher risk of mortality than their counterparts in cities seems to be emerging in African countries such as Ghana, Kenya and Uganda.
But Seyram Wordui, a paediatrician at the Korle-Bu Teaching Hospital in Ghana, said that the findings should be interpreted with caution.
“The demographic and health survey being a household questionnaire is fraught with bias. It is well documented that there is a lot of underreporting of neonatal events, especially deaths that happen outside the healthcare setting,” Wordui explained. “In some African cultures, when a newborn dies, the family takes it that the baby ‘was not meant to stay’, and the event is treated as if it never happened.”
Wordui added that supervised deliveries and appropriate newborn care practices tend to reduce newborn deaths.
“Urban areas in Sub-Saharan Africa usually have more health facilities and personnel, and this should translate into less neonatal morbidity (diseases) and mortality in urban areas,” she told SciDev.Net. “Any other conclusion needs further investigation before it can be used to guide interventions or inform policy.”