Babies born in cities face increased risk of death

Babies born in cities are at a surprisingly higher risk of dying in their first month of life compared to their counterparts in rural areas in Tanzania, a study has found.

In 2019, for every 1,000 live births in sub-Saharan Africa, 27 were more likely to die in the first month of life, a rate ten times that of children born in high-income countries, according to the World Health Organization. health.

But researchers say that while historically the number of babies who die in their first month of life per thousand babies born alive – also known as the neonatal mortality rate – has been higher in rural areas than in cities due With reduced access to health care in villages, the rural-urban differences in these deaths have narrowed in recent times.

The study published in BMJ Global Health this month (January 5) shows that for every 1,000 babies born alive, 20 in rural Tanzania die in their first month of life compared to 38 in cities.

Even after excluding the effect of other explanatory factors [such as babies with low birthweight], we have nevertheless seen that neonatal mortality in urban areas remains twice as high as that in rural areas.

Lenka Beňová, 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, says SciDev.Net that their findings show no concrete evidence of what might be causing the higher urban neonatal death rate. She said her research group planned to conduct further studies.

“For example, we want to make sure that we very accurately measure urban residence versus rural residence of mothers’ households, and that we take into account the confounding effect of neonatal deaths and stillbirths,” Beňová adds.

The study included analysis of disparities in neonatal mortality rates using Demographic and Health Surveys from 21 countries in sub-Saharan Africa. For Tanzania, researchers analyzed data from 2015-2016 to determine the association between residence in urban or rural areas and neonatal mortality after adjusting for risk factors, including household characteristics, low birthweight birth and the environment in which babies are born.

Of the 21 countries, only Tanzania had a significantly higher neonatal mortality rate in cities than in rural areas, according to the study.

Beňová says the results should alert national and local authorities that preventable neonatal deaths should be a big concern, even in areas where health care is more accessible, such as cities, and that there is a need. quality care for pregnant women and newborns. babies.

According to the study, the problem of urban infants being at higher risk of death than their city counterparts seems to be emerging in African countries such as Ghana, Kenya and Uganda.

But Seyram Wordui, a pediatrician at Korle-Bu Teaching Hospital in Ghana, says the results should be interpreted with caution.

“Because the Demographic and Health Survey is a household questionnaire, it is full of bias. It is well documented that there is a lot of under-reporting of neonatal events, especially deaths that occur outside of the scope of health care,” says Wordui. “In some African cultures, when a newborn baby dies, the family considers that the baby ‘wasn’t meant to stay’, and the event is treated as if it never happened.”

Wordui adds that supervised births and proper neonatal care practices tend to reduce newborn deaths.

“Urban areas in sub-Saharan Africa generally have more health facilities and personnel, which should translate into lower neonatal morbidity [diseases] and mortality in urban areas,” she says. SciDev.Net. “Any other findings require further investigation before they can be used to guide interventions or inform policy.”