Infants born in cities twice more likely to die early says report

Dar es Salaam. Babies born in cities are reportedly at increased risk of death in their first month of life compared with babies who are born in rural areas of Tanzania, a study has shows. This is despite the declining cild mortality trend reported by the Ministry of Health.
The neonatal mortality ratio trend published on the ministry’s website shows that the ratio declined from 32 percent in 1996 to 25 percent in 2016. But, the recent report published by the SciDev.

Net shows that in 2019, for every 1,000 live births in sub-Saharan Africa, 27 were more likely to die within the first month of life.
The rate according to the World Health Organisation (WHO) was ten times that of children born in high-income countries.
However, researchers say that although historically the number of babies who die in their first month of life per one thousand babies born alive — also called neonatal mortality rate — has been higher in rural areas than in urban centres because of decreased access to health-care in villages, the rural-urban differences in such deaths have been narrowing in recent times.
“We still saw that neonatal mortality in urban areas remained twice as much as that of rural areas,” said Lenka Beňová of the  Institute of Tropical Medicine, Belgium.
The study published in BMJ Global Health on January 5 this year shows that for every 1,000 babies born alive, 20 in rural Tanzania die in their first month of life compared with 38 in cities.
“Even after excluding the effect of other explanatory factors [such as babies with low birth weight], we still saw that neonatal mortality in urban areas remained twice as much as that of rural areas,” says Beňová, a co-author of the study.
But Ms 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 did 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,” Ms Beňová added. The study involved the analysis of disparities in newborn death rates using demographic and health surveys of 21 countries in sub-Saharan Africa.
For Tanzania, researchers analysed the 2015–2016 data to determine the association between residing in urban or rural areas and neonatal mortality after adjusting for risk factors including characteristics of the households, low birth weight, and the environment into which babies are born.
Of the 21 countries, only Tanzania had newborn death rate in cities being significantly more than that of rural areas, the study found.
Ms 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 newborn babies.
The issue of urban infants being at higher risk of dying than their counterparts in rural areas seems to be emerging in African countries such as Ghana, Kenya and Uganda, according to the study.
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 under-reporting of neonatal events, especially deaths that happen outside the health-care setting,” Wordui explained.
“In some African cultures, when a new-born dies, the family takes it that the baby ‘was not meant to live’, and the event is treated as if it never happened.”
Top Health Ministry officials couldn’t be available for comments yesterday, but a child specialist from the Muhimbili National Hospital (MNH), Dr Zaituni Bokhari said there wasn’t enough comprehensive study that has been done comparing the situation in urban and rural areas.
“This is surprising because the urban population is exposed to improved health-care services and higher awareness compared to their rural counterparts. Therefore, they can make early disease diagnosis and register a low neonatal mortality ratio,” she said.