scholarly journals A growing disadvantage of being born in an urban area? Analysing urban–rural disparities in neonatal mortality in 21 African countries with a focus on Tanzania

2022 ◽  
Vol 7 (1) ◽  
pp. e007544
Author(s):  
Megan Norris ◽  
Gonnie Klabbers ◽  
Andrea B Pembe ◽  
Claudia Hanson ◽  
Ulrika Baker ◽  
...  

IntroductionNeonatal mortality rate (NMR) has been declining in sub-Saharan African (SSA) countries, where historically rural areas had higher NMR compared with urban. The 2015–2016 Demographic and Health Survey (DHS) in Tanzania showed an exacerbation of an existing pattern with significantly higher NMR in urban areas. The objective of this study is to understand this disparity in SSA countries and examine the specific factors potentially underlying this association in Tanzania.MethodsWe assessed urban–rural NMR disparities among 21 SSA countries with four or more DHS, at least one of which was before 2000, using the DHS StatCompiler. For Tanzania DHS 2015–2016, descriptive statistics were carried out disaggregated by urban and rural areas, followed by bivariate and multivariable logistic regression modelling the association between urban/rural residence and neonatal mortality, adjusting for other risk factors.ResultsAmong 21 countries analysed, Tanzania was the only SSA country where urban NMR (38 per 1000 live births) was significantly higher than rural (20 per 1,000), with largest difference during first week of life. We analysed NMR on the 2015–2016 Tanzania DHS, including live births to 9736 women aged between 15 and 49 years. Several factors were significantly associated with higher NMR, including multiplicity of pregnancy, being the first child, higher maternal education, and male child sex. However, their inclusion did not attenuate the effect of urban–rural differences in NMR. In multivariable models, urban residence remained associated with double the odds of neonatal mortality compared with rural.ConclusionThere is an urgent need to understand the role of quality of facility-based care, including role of infections, and health-seeking behaviour in case of neonatal illness at home. However, additional factors might also be implicated and higher NMR within urban areas of Tanzania may signal a shift in the pattern of neonatal mortality across several other SSA countries.

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042654
Author(s):  
Yuxi Liu ◽  
Leni Kang ◽  
Chunhua He ◽  
Lei Miao ◽  
Xiaoqiong Qiu ◽  
...  

ObjectiveThe present study estimated the national and urban–rural levels and causes of neonatal deaths in China annually between 2014 and 2018 to provide data support for the further end of preventable neonatal deaths for China and other low-income and middle-income countries.MethodsThe study was based on data from the National Maternal and Child Health Surveillance System. All neonates of surveillance districts (gestational week: ≥28 weeks) who died after delivery have been involved in the study. The mortality rate and the leading causes of death for neonates were analysed.ResultsThe neonatal mortality rate (NMR) of China has steadily decreased from 5.9 deaths per 1000 live births in 2014 to 3.9 deaths per 1000 live births in 2018. The NMR in 2018 of urban and rural areas was 2.2 deaths per 1000 live births and 4.7 deaths per 1000 live births, respectively. The leading preventable causes of neonatal deaths are the same in the urban and rural areas were same, which were preterm birth, intrapartum complications and pneumonia. Mortality rates of these three causes fell significantly between 2014 and 2018 but contributed to a higher proportion of deaths in rural areas than urban areas. The proportion of preventable deaths accounted for 74.6% in 2018.ConclusionsThe NMR of China has decreased steadily from 2014 to 2018. However, the inequality between urban and rural areas still exists. The goal of government interventions should be to reduce the health inequality of neonates and further take targeted measures to eliminate preventable neonatal death.


2020 ◽  
Vol 78 (1) ◽  
Author(s):  
Sanni Yaya ◽  
Betregiorgis Zegeye ◽  
Bright Opoku Ahinkorah ◽  
Edward Kwabena Ameyaw ◽  
Abdul-Aziz Seidu ◽  
...  

Abstract Background Programmatic and research agendas surrounding neonatal mortality are important to help countries attain the child health related 2030 Sustainable Development Goal (SDG). In Burundi, the Neonatal Mortality Rate (NMR) is 25 per 1000 live births. However, high quality evidence on the over time evolution of inequality in NMR is lacking. This study aims to address the knowledge gap by systematically and comprehensively investigating inequalities in NMR in Burundi with the intent to help the country attain SDG 3.2 which aims to reduce neonatal mortality to at least as low as 12 per 1000 live births by 2030. Methods The Burundi Demographic and Health Survey (BDHS) data for the periods of 2010 and 2016 were used for the analyses. The analyses were carried out using the WHO’s HEAT version 3.1 software. Five equity stratifiers: economic status, education, residence, sex and subnational region were used as benchmark for measuring NMR inequality with time over 6 years. To understand inequalities from a broader perspective, absolute and relative inequality measures, namely Difference, Population Attributable Risk (PAR), Ratio, and Population Attributable Fraction (PAF) were calculated. Statistical significance was measured by computing corresponding 95% Confidence Intervals (CIs). Results NMR in Burundi in 2010 and 2016 were 36.7 and 25.0 deaths per 1000 live births, respectively. We recorded large wealth-driven (PAR = -3.99, 95% CI; − 5.11, − 2.87, PAF = -15.95, 95% CI; − 20.42, − 11.48), education related (PAF = -6.64, 95% CI; − 13.27, − 0.02), sex based (PAR = -1.74, 95% CI; − 2.27, − 1.21, PAF = -6.97, 95% CI; − 9.09, − 4.86), urban-rural (D = 15.44, 95% CI; 7.59, 23.29, PAF = -38.78, 95% CI; − 45.24, − 32.32) and regional (PAR = -12.60, 95% CI; − 14.30, − 10.90, R = 3.05, 95% CI; 1.30, 4.80) disparity in NMR in both survey years, except that urban-rural disparity was not detected in 2016. We found both absolute and relative inequalities and significant reduction in these inequalities over time - except at the regional level, where the disparity remained constant during the study period. Conclusion Large survival advantage remains to neonates of women who are rich, educated, residents of urban areas and some regions. Females had higher chance of surviving their 28th birthday than male neonates. More extensive work is required to battle the NMR gap between different subgroups in the country.


2019 ◽  
Vol 118 (8) ◽  
pp. 142-151
Author(s):  
Dr. Udayagiri Raghunath ◽  
Dr. V.Venkateswara Rao

The corporate companies dealing with FMCG products have started focusing on rural markets as the urban markets have become saturated and highly competitive. Capturing the rural markets brings forth a whole new set of challenges as it is laborious to break in. This market presents the companies with gamut challenges on a new dimension which demand entirely different strategies as compared to the ones used in urban areas. Studying the rural markets for rural markets has become crucial more than ever. It is an objective learning, psychiatry of dispersion, impact of the FMCG in rural areas. This research uses diverse utensils, procedure toward analyze composed records. Several of the features used in analyzing the data are the consumer characteristics like educational qualifications, professions they are in, and the income levels. The role of TV media advertising is also analyzed. Many deals and promotions advertised on TV are investigated. The scope of authority wield by publicity happening customer choice production has looked into. The different levels of media exposure and preferable TV watching times and their favorite programs considered while analyzing the data. The spending prototype of rural clients on FMCG is examined and further categorized based on their income levels, educational qualifications, and legal awareness of consumer act. All the analyzed data, results, and suggestions presented in the visual formats.


Land ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 807
Author(s):  
Simone Valeri ◽  
Laura Zavattero ◽  
Giulia Capotorti

In promoting biodiversity conservation and ecosystem service capacity, landscape connectivity is considered a critical feature to counteract the negative effects of fragmentation. Under a Green Infrastructure (GI) perspective, this is especially true in rural and peri-urban areas where a high degree of connectivity may be associated with the enhancement of agriculture multifunctionality and sustainability. With respect to GI planning and connectivity assessment, the role of dispersal traits of tree species is gaining increasing attention. However, little evidence is available on how to select plant species to be primarily favored, as well as on the role of landscape heterogeneity and habitat quality in driving the dispersal success. The present work is aimed at suggesting a methodological approach for addressing these knowledge gaps, at fine scales and for peri-urban agricultural landscapes, by means of a case study in the Metropolitan City of Rome. The study area was stratified into Environmental Units, each supporting a unique type of Potential Natural Vegetation (PNV), and a multi-step procedure was designed for setting priorities aimed at enhancing connectivity. First, GI components were defined based on the selection of the target species to be supported, on a fine scale land cover mapping and on the assessment of land cover type naturalness. Second, the study area was characterized by a Morphological Spatial Pattern Analysis (MSPA) and connectivity was assessed by Number of Components (NC) and functional connectivity metrics. Third, conservation and restoration measures have been prioritized and statistically validated. Notwithstanding the recognized limits, the approach proved to be functional in the considered context and at the adopted level of detail. Therefore, it could give useful methodological hints for the requalification of transitional urban–rural areas and for the achievement of related sustainable development goals in metropolitan regions.


2021 ◽  
pp. 001955612110016
Author(s):  
Anurima Mukherjee Basu ◽  
Rutool Sharma

Current urbanisation trends in India show a quantum jump in number of ‘census towns’, which are not statutorily declared as urban areas, but have acquired all characteristics of urban settlements. Sizeable number of such census towns are not located near any Class 1 city. Lack of proper and timely planning has led to unplanned growth of these settlements. This article is based on a review of planning legislations, institutional framework and planning process of four states in India. The present article analyses the scope and limitations of the planning process adopted in the rapidly urbanising rural areas of these states. The findings reveal that states are still following a conventional approach to planning that treats ‘urban’ and ‘rural’ as separate categories and highlights the need for adopting an integrated territorial approach to planning of settlements.


BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042762
Author(s):  
Shuai Yuan ◽  
Shao-Hua Xie

ObjectiveThe substantial differences in socioeconomic and lifestyle exposures between urban and rural areas in China may lead to urban–rural disparity in cancer risk. This study aimed to assess the urban–rural disparity in cancer incidence in China.MethodsUsing data from 36 regional cancer registries in China in 2008–2012, we compared the age-standardised incidence rates of cancer by sex and anatomic site between rural and urban areas. We calculated the rate difference and rate ratio comparing rates in rural versus urban areas by sex and cancer type.ResultsThe incidence rate of all cancers in women was slightly lower in rural areas than in urban areas, but the total cancer rate in men was higher in rural areas than in urban areas. The incidence rates in women were higher in rural areas than in urban areas for cancers of the oesophagus, stomach, and liver and biliary passages, but lower for cancers of thyroid and breast. Men residing in rural areas had higher incidence rates for cancers of the oesophagus, stomach, and liver and biliary passages, but lower rates for prostate cancer, lip, oral cavity and pharynx cancer, and colorectal cancer.ConclusionsOur findings suggest substantial urban–rural disparity in cancer incidence in China, which varies across cancer types and the sexes. Cancer prevention strategies should be tailored for common cancers in rural and urban areas.


2008 ◽  
Vol 40 (1) ◽  
pp. 83-96 ◽  
Author(s):  
M. MAZHARUL ISLAM ◽  
KAZI MD ABUL KALAM AZAD

SummaryThis paper analyses the levels and trends of childhood mortality in urban Bangladesh, and examines whether children’s survival chances are poorer among the urban migrants and urban poor. It also examines the determinants of child survival in urban Bangladesh. Data come from the 1999–2000 Bangladesh Demographic and Health Survey. The results indicate that, although the indices of infant and child mortality are consistently better in urban areas, the urban–rural differentials in childhood mortality have diminished in recent years. The study identifies two distinct child morality regimes in urban Bangladesh: one for urban natives and one for rural–urban migrants. Under-five mortality is higher among children born to urban migrants compared with children born to life-long urban natives (102 and 62 per 1000 live births, respectively). The migrant–native mortality differentials more-or-less correspond with the differences in socioeconomic status. Like childhood mortality rates, rural–urban migrants seem to be moderately disadvantaged by economic status compared with their urban native counterparts. Within the urban areas, the child survival status is even worse among the migrant poor than among the average urban poor, especially recent migrants. This poor–non-poor differential in childhood mortality is higher in urban areas than in rural areas. The study findings indicate that rapid growth of the urban population in recent years due to rural-to-urban migration, coupled with higher risk of mortality among migrant’s children, may be considered as one of the major explanations for slower decline in under-five mortality in urban Bangladesh, thus diminishing urban–rural differentials in childhood mortality in Bangladesh. The study demonstrates that housing conditions and access to safe drinking water and hygienic toilet facilities are the most critical determinants of child survival in urban areas, even after controlling for migration status. The findings of the study may have important policy implications for urban planning, highlighting the need to target migrant groups and the urban poor within urban areas in the provision of health care services.


2010 ◽  
Vol 10 (19) ◽  
pp. 9563-9578 ◽  
Author(s):  
C. C.-K. Chou ◽  
C. T. Lee ◽  
M. T. Cheng ◽  
C. S. Yuan ◽  
S. J. Chen ◽  
...  

Abstract. To investigate the physico-chemical properties of aerosols in Taiwan, an observation network was initiated in 2003. In this work, the measurements of the mass concentration and carbonaceous composition of PM10 and PM2.5 are presented. Analysis on the data collected in the first 5-years, from 2003 to 2007, showed that there was a very strong contrast in the aerosol concentration and composition between the rural and the urban/suburban stations. The five-year means of EC at the respective stations ranged from 0.9±0.04 to 4.2±0.1 μgC m−3. In rural areas, EC accounted for 2–3% of PM10 and 3–5% of PM2.5 mass loadings, comparing to 4–6% of PM10 and 4–8% of PM2.5 in the urban areas. It was found that the spatial distribution of EC was consistent with CO and NOx across the network stations, suggesting that the levels of EC over Taiwan were dominated by local sources. The measured OC was split into POC and SOC counterparts following the EC tracer method. Five-year means of POC ranged from 1.8±0.1 to 9.7±0.2 μgC m−3 among the stations. It was estimated that the POM contributed 5–17% of PM10 and 7–18% of PM2.5 in Taiwan. On the other hand, the five-year means of SOC ranged from 1.5±0.1 to 3.8±.3 μgC m−3. The mass fractions of SOM were estimated to be 9–19% in PM10 and 14–22% in PM2.5. The results showed that the SOC did not exhibit significant urban-rural contrast as did the POC and EC. A significant cross-station correlation between SOC and total oxidant was observed, which means the spatial distribution of SOC in Taiwan was dominated by the oxidant mixing ratio. Besides, correlation was also found between SOC and particulate nitrate, implying that the precursors of SOA were mainly from local anthropogenic sources. In addition to the spatial distribution, the carbonaceous aerosols also exhibited distinct seasonality. In northern Taiwan, the concentrations of all the three carbonaceous components (EC, POC, and SOC) reached their respective minima in the fall season. POC and EC increased drastically in winter and peaked in spring, whereas the SOC was characterized by a bimodal pattern with the maximal concentration in winter and a second mode in summertime. In southern Taiwan, minimal levels of POC and EC occurred consistently in summer and the maxima were observed in winter, whereas the SOC peaked in summer and declined in wintertime. The discrepancies in the seasonality of carbonaceous aerosols between northern and southern Taiwan were most likely caused by the seasonal meteorological settings that dominated the dispersion of air pollutants. Moreover, it was inferred that the Asian pollution outbreaks could have shifted the seasonal maxima of air pollutants from winter to spring in the northern Taiwan, and that the increases in biogenic SOA precursors and the enhancement in SOA yield were responsible for the elevated SOC concentrations in summer.


2021 ◽  
Vol 10 (1) ◽  
pp. 32-44
Author(s):  
Irina Bancescu

Rural areas in Romania are underdeveloped, with the main economic activity being agriculture. Urban-rural income gap and poverty levels are indicative of an underdeveloped rural area. Urban-rural absolute income gap for average monthly income increased from 352 RON in 2007 to 663 RON in 2017. Moreover, the work poverty rate is higher in rural areas than in urban areas. Economic rural development can be achieved by improvements of the labour market and introduction of new value-added products. Agricultural and non-agricultural activities are dependent on each other for a successful rural development leading to poverty alleviation. An industry that combines the two types of economic activities is agriculture biomaterial industry. In this paper, the authos investigates the factors influencing rural poverty and analyses the current stage of the bioplastics market in Romania and its economic implications. Bioplastics industry can reduce urban-rural income gaps and poverty in rural areas.


2020 ◽  
Author(s):  
Qifang Bi ◽  
Derek AT Cummings ◽  
Nicholas G. Reich ◽  
Lindsay T. Keegan ◽  
Joshua Kaminsky ◽  
...  

AbstractIn Southeast Asia, endemic dengue follows strong spatio-temporal patterns with major epidemics occurring every 2-5 years. However, important spatio-temporal variation in seasonal dengue epidemics remains poorly understood. Using 13 years (2003-2015) of dengue surveillance data from 926 districts in Thailand and wavelet analysis, we show that rural epidemics lead urban epidemics within a dengue season, both nationally and within health regions. However, local dengue fade-outs are more likely in rural areas than in urban areas during the off season, suggesting rural areas are not the source of viral dispersion. Simple dynamic models show that stronger seasonal forcing in rural areas could explain the inconsistency between earlier rural epidemics and dengue “over wintering” in urban areas. These results add important nuance to earlier work showing the importance of urban areas in driving multi-annual patterns of dengue incidence in Thailand. Feedback between geographically linked locations with markedly different ecology is key to explaining full disease dynamics across urban-rural gradient.


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