ArticleBMJ global health2023
Neonatal and perinatal mortality in the urban continuum: a geospatial analysis of the household survey, satellite imagery and travel time data in Tanzania.
Article in BMJ global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Impact of travel time to health facilities on perinatal outcomes: a systematic review with narrative synthesis and meta-analysis.Journal of global health · 2026Pooled it
- The richness of urban health realities lost in measurement monocultures.BMJ global health · 2026Article
- Estimating rates of treatment delay for malaria fevers among children in Sub-Saharan Africa 2006-2022.Nature communications · 2025Article
- From poverty to health: intraurban inequalities in child health indicators in low-income and middle-income countries during the SDG era.BMJ global health · 2025Article
- Exploring the Factors Underlying the Narrowing Urban Advantage in Child Mortality in Sub-Saharan Africa: A Scoping Review.Journal of urban health : bulletin of the New York Academy of Medicine · 2025Article
- Risk factors of under-five mortality in Tanzania: insights from the Tanzania Demographic and Health Survey 2022.BMJ global health · 2025Article
- Multilevel modelling of determinants of perinatal mortality in East Africa: a pooled analysis of National health survey data.BMC public health · 2025Article
- Disclosing possible nonmedically indicated cesarean sections in 5 high-volume urban maternity units in Tanzania: a criterion-based clinical audit.AJOG global reports · 2025Article
- Timing of cesarean section for prolonged labor in urban Tanzania: A criterion-based audit.AJOG global reports · 2024Article
- Incidence and determinants of perinatal mortality in five urban hospitals in Dar es Salaam, Tanzania: a cohort study with an embedded case-control analysis.BMC pregnancy and childbirth · 2024Article
- Length-of-stay and factors associated with early discharge after birth in health facilities in Guinea by mode of birth: Secondary analysis of Demographic and Health Survey 2018.PLOS global public health · 2024Article
- Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi.PloS one · 2024Article
- A geospatial database of close-to-reality travel times to obstetric emergency care in 15 Nigerian conurbations.Scientific data · 2023Article
- Exploring the urban gradient in population health: insights from satellite-derived urbanicity classes across multiple countries and years in sub-Saharan Africa.BMJ global health · 2023Review
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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.
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