Abstract
ObjectiveTo explore trends in socioeconomic disparities and under-five mortality rates in rural parts of the United Republic of Tanzania between 2000 and 2011.MethodsWe used longitudinal data on births, deaths, migrations, maternal educational attainment and household characteristics from the Ifakara and Rufiji health and demographic surveillance systems. We estimated hazard ratios (HR) for associations between mortality and maternal educational attainment or relative household wealth, using Cox hazard regression models.FindingsThe under-five mortality rate declined in Ifakara from 132.7 deaths per 1000 live births (95% confidence interval, CI: 119.3–147.4) in 2000 to 66.2 (95% CI: 59.0–74.3) in 2011 and in Rufiji from 118.4 deaths per 1000 live births (95% CI: 107.1–130.7) in 2000 to 76.2 (95% CI: 66.7–86.9) in 2011. Combining both sites, in 2000–2001, the risk of dying for children of uneducated mothers was 1.44 (95% CI: 1.08–1.92) higher than for children of mothers who had received education beyond primary school and in 2010–2011, the HR was 1.18 (95% CI: 0.90–1.55). In contrast, mortality disparities between richest and poorest quintiles worsened in Rufiji, from 1.20 (95% CI: 0.99–1.47) in 2000–2001 to 1.48 (95% CI: 1.15–1.89) in 2010–2011, while in Ifakara, disparities narrowed from 1.30 (95% CI: 1.09–1.55) to 1.15 (95% CI: 0.95–1.39) in the same period.ConclusionWhile childhood survival has improved, mortality disparities still persist, suggesting a need for policies and programmes that both reduce child mortality and address socioeconomic disparities.
Highlights
Despite evidence that social, demographic and residential disparities in the mortality of children younger than 5 years have declined, in many low-income countries – especially in sub-Saharan Africa – such disparities still exist.[1]
Measures of socioeconomic status such as poverty,[2,3,4,5,6,7] maternal educational attainment,[5,8,9,10] social class,[11,12] geographical setting,[13,14] and rural and remote residence[15,16] have all been shown to be associated with under-five mortality rates
In the United Republic of Tanzania, the under-five mortality rate has declined by 40% from 137 deaths per 1000 live births in 1992–1996 to 81 in 2006–2010.17–20 there are still disparities in risk of death among children younger than 5 years
Summary
Demographic and residential disparities in the mortality of children younger than 5 years have declined, in many low-income countries – especially in sub-Saharan Africa – such disparities still exist.[1]. In the United Republic of Tanzania, the under-five mortality rate has declined by 40% from 137 deaths per 1000 live births in 1992–1996 to 81 in 2006–2010.17–20 there are still disparities in risk of death among children younger than 5 years. We describe the mortality transition between 2000 and 2011 in three rural districts of the United Republic of Tanzania and show the longitudinal associations with indicators of health equity, i.e. maternal and household factors
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