Peer-reviewed article
Erosion of the capital city advantage in child survival and reproductive, maternal, newborn and child Health intervention coverage in sub-Saharan Africa
Agbessi Amouzou, Dessalegn Y. Melesse, Fernando C. Wehrmeister, Leonardo Z. Ferreira, Safia S. Jiwani et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study looked at whether children in capital cities in sub-Saharan Africa still survive at higher rates than children in other urban and rural areas. Using survey data from 39 countries between 1990 and 2020, the researchers tracked child death rates and access to health services by place of residence. They found that the gap between rural areas and capital cities has shrunk a lot since 2000, mainly because rural areas are improving faster. In Eastern Africa, the survival gap between capital cities and rural areas had almost disappeared by 2015. The authors warn that health improvements in cities themselves, especially for poorer city residents, seem to be slowing down.
Key points
- The gap in child deaths between rural areas and capital cities fell from 41 to 23 per 1000 live births between 2000 and 2015.
- The gap between rural areas and other urban areas fell from 26 to 15 per 1000 live births in the same period.
- Rural areas are progressing faster than capital cities and other urban areas in both child survival and health service coverage.
- In Eastern Africa the under-five mortality gap between capital cities and rural areas had almost closed by 2015.
- The findings suggest capital cities are losing their historical health advantage, with slower improvement inside urban areas.
Limitations
The abstract does not explain how inequality within urban areas (such as slums versus wealthier neighbourhoods) was measured, so it is unclear how much of the 'urban advantage' erosion is driven by poor urban residents specifically.
Abstract
Abstract The place of residence is a major determinant of RMNCH outcomes, with rural areas often lagging in sub-Saharan Africa. This long-held pattern may be changing given differential progress across areas and increasing urbanization. We assessed inequalities in child mortality and RMNCH coverage across capital cities, other urban and rural areas. We analyzed mortality data from 162 DHS and MICS in 39 countries with the most recent survey conducted between 1990 and 2020, and RMNCH coverage data from 39 countries. We assessed inequality trends in neonatal and under-five mortality and in RMNCH coverage using multilevel linear regression models. Under-five mortality and RMNCH service coverage inequalities by place of residence have reduced substantially in sub-Saharan Africa, with rural areas experiencing faster progress than other areas. The absolute gap in child mortality between rural areas and capital cities, and that between rural and other urban areas reduced respectively from 41 and 26 deaths per 1000 live births in 2000 to 23 and 15 by 2015. Capital cities are losing their primacy in child survival and RMNCH coverage over other urban areas and rural areas, especially in Eastern Africa where under-five mortality gap between capital cities and rural areas closed almost completely by 2015. While child mortality and RMNCH coverage inequalities are closing rapidly by place of residence; slow trends in capital cities and urban areas suggest gradual erosion of capital city and urban health advantage. Monitoring child mortality and RMNCH coverage trends in urban areas, especially among the urban poor, and addressing factors of within urban inequalities are urgently needed.