SEARCHCOHORTpediatrics, obstetrics and gynecology

cohort·pediatrics, obstetrics and gynecology, epidemiology, public health·PMC10083757

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

BMJ Global Health · 7 authors, 7 centres

AI SUMMARY

FIDELITY 100%

POPULATION8915 pregnancies among 6156 women of reproductive age from the Tanzania Demographic and Health Survey (DHS) 2015–2016.

INTERVENTIONExposure to different levels of urbanicity (core urban, semi-urban, rural) as defined by satellite imagery and population density data.

COMPARISONRural clusters.

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AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

This study used Tanzania household survey data and satellite imagery to define a three-level urbanicity gradient and found higher odds of neonatal and perinatal death in core urban areas compared to rural areas, though these associations were not statistically significant in the final models.

Full summary

1,086 CHARS

This geospatial analysis used data from the 2015–2016 Tanzania DHS to assess neonatal and perinatal mortality across a gradient of urbanicity defined by satellite imagery. The study analyzed 8915 pregnancies, finding the highest mortality rates in core urban areas and the lowest in rural areas. Bivariate models showed significantly higher odds of neonatal death (OR=1.85) and perinatal death (OR=1.60) in core urban versus rural clusters. In multivariable models adjusting for factors like maternal age, education, and care access, these associations remained but were not statistically significant, likely due to small death sample sizes. Travel time to the nearest hospital was not associated with mortality. The study highlights that urban areas are not monolithic, with core urban neighborhoods facing disproportionately high mortality. Limitations include potential misclassification of stillbirths and the inability to test for interactions due to sample size. Implications suggest a need for targeted interventions in high-density urban areas to meet mortality reduction goals.

PICO

PPOPULATION

8915 pregnancies among 6156 women of reproductive age from the Tanzania Demographic and Health Survey (DHS) 2015–2016.

IINTERVENTION

Exposure to different levels of urbanicity (core urban, semi-urban, rural) as defined by satellite imagery and population density data.

OOUTCOME

Neonatal death and perinatal death.

STUDY TYPE

cohort

SPECIALTY

pediatrics

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10083757

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

BMJ Global Health

READ THE FULL PAPER

ABSTRACT

Introduction Recent 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. Methods The 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. Results Both 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. Conclusion Addressing 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.

CITATION EXPORT

Peter M Macharia, Lenka Beňová, Jessie Pinchoff et al.. Neonatal and perinatal mortality in the urban continuum: a geospatial analysis of the household survey, satellite imagery and travel time data in Tanzania. BMJ Global Health. (2023). https://doi.org/10.1136/bmjgh-2022-011253

AUTHORS

7 · 7 CENTRES

Peter M Macharia, Lenka Beňová, Jessie Pinchoff, Aline Semaan, Andrea B Pembe, Aliki Christou, Claudia Hanson

1Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
2Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
3Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
4Social and Behavioral Sciences Research, Population Council, New York City, New York, USA
5Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
6Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
7Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK