The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #55231

Jacob A. Adetunji, PhD, Office of Population, Bureau for Global Health, USAID, GH/PRH/PEC, Rm. 3.06-25, RRB, Washington, DC 20523, 202 712-4095, jadetunji@usaid.gov

This paper sets out to answer two basic questions: Is the health of rural infants and under-five children getting better or worse in sub-Saharan Africa? Is the rural-urban gap in mortality among under-five children getting narrower as urban poverty levels increase in the region? To answer these questions, we analyzed data from 18 sub-Saharan African countries that have participated at least twice in the Demographic and Health Surveys program since 1988.

The results show that the health of rural children is getting worse in most countries. Over the past fifteen yeas, rural infant mortality rates increased significantly in 10 of the 18 countries: by 33% in Rwanda and by 30% in Cote d’Ivoire. Similarly, rural under-five mortality rates increased in half of the countries: by 36% in Rwanda, and by 33% in Zimbabwe. Large rural-urban gaps in infant and under-five mortality rates were found in all 18 countries in this study. Infant mortality rates were at least 50% higher in rural areas in nine countries, and under-five mortality rates were at least 50% higher in eight countries. Unfortunately, the urban advantage in childhood mortality is not disappearing: rural-urban gaps in infant mortality widened in 11 countries and narrowed only in six. Rural-urban gaps in under-five mortality widened in 10 countries and narrowed only in five. Multivariate methods were employed to assess the contributions of socioeconomic, demographic and behavioral factors to the rural-urban gaps, and policy implications of the findings are drawn.

Learning Objectives:

By the end of this presentation, participant will:
• Realize that the health of under-five children is getting worse in rural areas of most of the countries that we studied,
• Realize that wide rural-urban gaps exist in the health of under-five children in Africa and appreciate the extent of the urban advantage,
• Recognize that the rural-urban gap in child survival prospects is not narrowing over time in the region,
• Be able to identify two or more reasons why the health of rural children continues falter in the region and recommend what could be done to ameliorate the situation.

Keywords: Child Health, Infant Mortality

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.