Background and rationale - Place of residence is a major determinant of key reproductive, maternal, neonatal and child health outcomes, with those living in rural areas traditionally having worse health outcomes than those in urban areas. In recent years, many countries in sub-Saharan Africa have seen massive rural to urban migration, mostly to the capital cities. As a result, there has been a surge in informal settlements, accompanied by a decline in previous improvement of essential intervention coverage and child mortality in urban areas. The latest United Nations estimates indicate that 54% of the sub-Saharan urban population lives in informal settlements. Deceleration in urban intervention coverage, along with the projection that close to half of the population in sub-Sahara Africa will be urban by 2030, called for action to produce evidence addressing coverage trends and inequities in large cities.
Research questions and participating countries: Part One – Countdown collaborations in 14 countries conducted secondary analysis of survey and health facility data to analyze coverage trends, inequities, health services and utilization related to maternal, newborn and child health. The cities included were Accra, Ghana; Lusaka, Zambia; Dakar, Senegal; Bamako, Mali; Ouagadougou, Burkina Faso; Kampala, Uganda; Nairobi, Kenya; Dar es Salaam, Tanzania; and Addis Ababa, Ethiopia.
Some papers from part one have been published in the Journal of Urban Health, while others are still in peer review. The papers published so far are:
Lankoandé and co-authors (2024) Inequalities and Trends in Under-Five Mortality Between Formal and Informal Areas in Ouagadougou, Burkina Faso
Amouzou and co-authors (2024) Erosion of the Capital City Advantage in Child Survival and Reproductive, Maternal, Newborn, and Child Health Intervention Coverage in Sub-Saharan Africa
Jacobs and co-authors (2024) Trends and Inequalities in Maternal and Newborn Health Services for Unplanned Settlements of Lusaka City, Zambia
Mekonnen and co-authors (2024) Inter-district and Wealth-related Inequalities in Maternal and Child Health Service Coverage and Child Mortality within Addis Ababa City
Sy and co-authors (2024) Spatial and Socioeconomic Inequalities in Cesarean Section Deliveries in Urban Settings in Dakar, Senegal
Kananura and co-authors (2024) Deprivation and Its Association with Child Health and Nutrition in the Greater Kampala Metropolitan Area of Uganda
Kagoye and co-authors (2024) High Child Mortality and Interventions Coverage in the City of Dar e Salam, Tanzania: Are the Poorest Paying an Urban Penalty?
Wehrmeister and co-authors (2024) Identifying and Characterizing the Poorest Urban Population Using National Household Surverys in 38 Cities in Sub-Saharan Africa
Blumenberg and co-authors (2023) Coverage, Trends and Inequalities of Maternal, Newborn and Child Health Inidicators among the Poor and Non-Poor in the Most Populous Cities from 38 Sub-Saharan African Countries
Dwomoh and co-authors (2023) Impact of Urban Slum Residence on Coverage of Maternal, Neonatal, and Child Health Service Indicators in the Greater Accra Region of Ghana: an Ecological Time-Series Analysis, 2018–2021
Research questions and participating countries: Part Two – Primary data were collected in four cities: Nairobi, Lusaka, Ouagadougou and Dakar. In Nairobi, Lusaka and Ouagadougou, the study objective was to evaluate the quality of maternal and newborn health services available to the urban poorest populations living in slums and informal settlements, specifically focusing on experience of person-centered maternity care, and readiness of facilities to offer essential maternal and newborn health services. In Dakar, the aim was to assess the spatial and financial accessibility of cesarean sections among urban slum dwellers.
Click here to read key findings and recommendations from the primary research and download the policy briefs. Also access the Nairobi Urban Health report here.