Rural-urban disparities in the health of children in Africa

Jacob A. Adetunji, U.S. Agency for International Development (USAID)

This paper investigates three research questions: Is the health of under-five children in rural Africa getting better or worse? Is the rural-urban gap in mortality among under-five children narrowing as urban poverty levels increase in the region? To what extent is the rural-urban health gap a function of socioeconomic differences between parents in rural and urban areas of Africa? DHS data from 18 sub-Saharan African countries were analyzed using multivariate and bivariate techniques. We found that the health of rural children is getting worse in most countries. Rural under-five mortality rates increased in half of the countries. Large rural-urban gaps in under-five mortality rates were found in all 18 countries studied. The urban advantage in childhood mortality is not disappearing over time: rural-urban gaps in under-five mortality widened in 10 countries and narrowed in five. Socioeconomic and behavioral factors account for much of the gap, but not in all countries.