ArticleJournal of urban health : bulletin of the New York Academy of Medicine2024
High Child Mortality and Interventions Coverage in the City of Dar es Salaam, Tanzania: Are the Poorest Paying an Urban Penalty?
Article in Journal of urban health : bulletin of the New York Academy of Medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Influence of climate variability and seasonal trends on malaria incidence in Dar es Salaam, Tanzania using generalized additive models.Epidemiology and infection · 2026Article
- Impact of interprofessional blended learning with low-fidelity simulation on neonatal resuscitation skills among interns: a quasi-experimental study in Tanzania.Advances in simulation (London, England) · 2026Article
- 'One woman, one bed': prevalence and factors associated with women's experiences of respectful birth in urban Dar es Salaam, Tanzania - across-sectional survey.Global health action · 2025Article
- Inequalities and Determinants of Quality Antenatal Care Coverage Among Women of Reproductive Age (15-49) in Tanzania: A Cross-Sectional Analysis of National Data.Health science reports · 2025Article
- Progress in Maternal, Newborn, and Child Health in Cities in Sub-Saharan Africa: Are Wide Inequities Holding Back Cities?Journal of urban health : bulletin of the New York Academy of Medicine · 2024Article
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13 authors.
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Abstract
The 'urban penalty' in health refers to the loss of a presumed survival advantage due to adverse consequences of urban life. This study investigated the levels and trends in neonatal, post-neonatal and under-5 mortality rate and key determinants of child survival using data from Tanzania Demographic and Health Surveys (TDHS) (2004/05, 2010 and 2015/16), AIDS Indicator Survey (AIS), Malaria Indicator survey (MIS) and health facility data in Tanzania mainland. We compared Dar es Salaam results with other urban and rural areas in Tanzania mainland, and between the poorest and richest wealth tertiles within Dar es Salaam. Under-5 mortality declined by 41% between TDHS 2004/05 and 2015/2016 from 132 to 78 deaths per 1000 live births, with a greater decline in rural areas compared to Dar es Salaam and other urban areas. Neonatal mortality rate was consistently higher in Dar es Salaam during the same period, with the widest gap (> 50%) between Dar es Salaam and rural areas in TDHS 2015/2016. Coverage of maternal, new-born and child health interventions as well as living conditions were generally better in Dar es Salaam than elsewhere. Within the city, neonatal mortality was 63 and 44 per 1000 live births in the poorest 33% and richest 33%, respectively. The poorest had higher rates of stunting, more overcrowding, inadequate sanitation and lower coverage of institutional deliveries and C-section rate, compared to richest tertile. Children in Dar es Salaam do not have improved survival chances compared to rural children, despite better living conditions and higher coverage of essential health interventions. This urban penalty is higher among children of the poorest households which could only partly be explained by the available indicators of coverage of services and living conditions. Further research is urgently needed to understand the reasons for the urban penalty, including quality of care, health behaviours and environmental conditions.
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