Neonatal and perinatal mortality in the urban continuum: a geospatial analysis of the household survey, satellite imagery and travel time data in Tanzania

Abstract

IntroductionRecent studies suggest that the urban advantage of lower neonatal mortality in urban compared with rural areas may be reversing, but methodological challenges include misclassification of neonatal deaths and stillbirths, and oversimplification of the variation in urban environments. We address these challenges and assess the association between urban residence and neonatal/perinatal mortality in Tanzania.MethodsThe Tanzania Demographic and Health Survey (DHS) 2015–2016 was used to assess birth outcomes for 8915 pregnancies among 6156 women of reproductive age, by urban or rural categorisation in the DHS and based on satellite imagery. The coordinates of 527 DHS clusters were spatially overlaid with the 2015 Global Human Settlement Layer, showing the degree of urbanisation based on built environment and population density. A three-category urbanicity measure (core urban, semi-urban and rural) was defined and compared with the binary DHS measure. Travel time to the nearest hospital was modelled using least-cost path algorithm for each cluster. Bivariate and multilevel multivariable logistic regression models were constructed to explore associations between urbanicity and neonatal/perinatal deaths.ResultsBoth neonatal and perinatal mortality rates were highest in core urban and lowest in rural clusters. Bivariate models showed higher odds of neonatal death (OR=1.85; 95% CI 1.12 to 3.08) and perinatal death (OR=1.60; 95% CI 1.12 to 2.30) in core urban compared with rural clusters. In multivariable models, these associations had the same direction and size, but were no longer statistically significant. Travel time to the nearest hospital was not associated with neonatal or perinatal mortality.ConclusionAddressing high rates of neonatal and perinatal mortality in densely populated urban areas is critical for Tanzania to meet national and global reduction targets. Urban populations are diverse, and certain neighbourhoods or subgroups may be disproportionately affected by poor birth outcomes. Research must capture, understand and minimise risks specific to urban settings.

Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi

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“…Most of these deaths could have been prevented with better healthcare and interventions [3,4]. However, burden remain in high in most disadvantaged in urban slums and rural areas, where poverty, inadequate sanitation, and limited access to healthcare increase the risk of these event [5,6].…”

A geospatial database of close-to-reality travel times to obstetric emergency care in 15 Nigerian conurbations

“…This is happening at a time when the use of health facilities for childbirth is near universal (>90%) 3 in African urban conurbations (a city area containing many people, formed by various towns growing and merging ( https://dictionary.cambridge.org/dictionary/english/conurbation )). Yet, emerging evidence shows that the odds of maternal death and stillbirth are significantly higher in urban areas compared to rural areas 25 – 27 . Consequently, spatial accessibility to EmOC in African urban settings has never been more crucial if we are to avert maternal and stillbirths and reach the 2030 Sustainable Development Goals (SDG) 28 on maternal and newborn deaths.…”

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