Journal of urban health : bulletin of the New York Academy of Medicine
-
In sub-Saharan Africa, urban areas generally have better access to and use of maternal, newborn, and child health (MNCH) services than rural areas, but previous research indicates that there are significant intra-urban disparities. This study aims to investigate temporal trends and geographic differences in maternal, newborn, and child health service utilization between Addis Ababa's poorest and richest districts and households. A World Bank district-based poverty index was used to classify districts into the top 60% (non-poor) and bottom 40% (poor), and wealth index data from the Ethiopian Demographic and Health Survey (EDHS) was used to classify households into the top 60% (non-poor) and bottom 40% (poor). ⋯ The neonatal mortality rate was nearly twice as high in the bottom 40% of households' as in the top 60% of households. Similarly, the under-5 mortality rate was three times higher in the bottom 40% compared to the top 60% of households. The substantial inequalities in MNCH service utilization and child mortality in Addis Ababa highlight the need for greater focus on the city's women and children living in the poorest households and districts in maternal, newborn, and child health programs.
-
Coverage levels of maternal and neonatal health services in Mali's major cities vary due to the combined effect of several factors, including poverty and migration to urban centers. This worsened from 2012 due to the security crisis. We conducted an analysis of the trends and differences in several indicators of maternal and neonatal care coverage in Bamako using secondary data from Mali's Demographic and Health Surveys from 2001 to 2018. ⋯ The results suggested an opposite pattern for postnatal care of newborns, with a difference of 6.8 percentage points of coverage in favor of the poor in 2018. The high coverage of maternal and newborn health interventions in Bamako city conceals intra-urban disparities to the detriment of poor migrant women and those who recently migrated to the city, partly due to the conflicts and security issues. A redefinition of health programs to include such targets would be desirable from an equity perspective.
-
African cities are experiencing increasing living standard disparities with limited evidence of intra-urban health disparities. Using data from the 2006-2016 Uganda Demographic and Health Surveys, we employed the UN-Habitat definition to examine slum-like household conditions in the Greater Kampala Metropolitan Area (GKMA). Subsequently, we developed a slum-like severity index and assessed its association with under-5 common morbidities and healthcare access. ⋯ Children in GKMA living in slum-like household conditions were more likely to experience diarrhea (moderate: OR = 1.21[95% CI: 1.05-1.39], severe: OR = 1.47 [95% CI: 1.27-1.7]); fever (moderate: OR = 2.67 [95% CI: 1.23-5.8], severe: OR = 3.09 [95% CI: 1.63-5.85]); anemia (moderate: OR = 1.18 [95% CI: 0.88-1.58], severe: OR = 1.44 [95% CI: 1.11-1.86]); and stunting (moderate: OR = 1.23 [95% CI: 1.23-1.25], severe: OR = 1.40 [95% CI: 1.41-1.47]) compared to those living in less slum-like conditions. However, seeking treatment for fever was less likely in slum-like household conditions, and the association of slum-like household conditions with diarrhea was insignificant. These findings underscore the precarious urban living conditions and the need for targeted health interventions addressing the social determinants of health in urban settings.
-
Rapid urbanization is likely to be associated with suboptimal access to essential health services. This is especially true in cities from sub-Saharan Africa (SSA), where urbanization is outpacing improvements in infrastructure. We assessed the current situation in regard to several markers of maternal, newborn, and child health, including indicators of coverage of health interventions (demand for family planning satisfied with modern methods, at least four antenatal care visits (ANC4+), institutional birth, and three doses of DPT vaccine[diphtheria, pertussis and tetanus]) and health status (stunting in children under 5 years, neonatal and under-5 mortality rates) among the poor and non-poor in the most populous cities from 38 SSA countries. ⋯ The gaps in coverage between the two groups were reducing, except for ANC4, with similar median average annual rate of change in both groups. Similar rates of change were also observed for stunting and the mortality indicators. Continuation of these positive trends is needed to eliminate inequalities in essential health services and child survival in SSA cities.