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The Effects of Population Growth
on the Achievement of the MDG
on Child Mortality in Urban SubSaharan Africa
Memorandum Submitted to the UK APPG-PDRH
By APHRC, Nairobi, Kenya
Dr Jean-Christophe Fotso, Dr Alex Ezeh
Dr Nyovani Madise, and Mr James Ciera
London, UK, June 5, 2006
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Is SSA on Target to Meeting the MDG?
Under-five mortality rate .
200
180
-13%
160
140
120
100
80
-67%
60
40
1990
1995
Real (1990-2003)
2000
2005
Trend (2003-2015)
2010
2015
MDG
Current and projected trends in under-five mortality in SSA
Source: UNICEF (data online)
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Why Should we Focus on Urban Areas?

Urban explosion amidst declining economies
•
•
•

Increasing proportion of urban dwellers
living below the poverty line in slums and
shantytowns
•
•

15% in 1950; 32% in 1990; 54% in 2030
Urban population growth of 4.7% in 1980-2000
Decline in per capita GDP by 0.8%
Unsafe drinking water and poor environmental
sanitation
Limited access to health facilities
Increased susceptibility of slum children to
various health problems
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The Evidence
Change (%) in UU5MR
3
1
-1
-3
-5
-7
2
3
6
5
4
Annual Urban Population Growth (%)
7
8
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Implications

Failing to target the urban poor:
•
•

Pulling down of national average of health
indicators
Move countries away from achieving the MDG on
child mortality
Newly assembled evidence indicates:
•
•
Gradual shift in the locus of poverty from rural to
urban areas
Higher levels of morbidity and mortality among
urban poor children than among their rural
counterparts (Nairobi, Kenya)
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Case Study in Nairobi, Kenya
150
134
117
125
100
88
94
87 84
76
76
71
75
68 70
52
50
24
25
33
19
0
Under-five mortality rate
Urban 1993
Urban 1998
Access to clean water (%)
Urban 2003
Health facility deliveries (%)
Nairobi Slums 2000
Rural 2003
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Poor-rich fertility gaps
48
50
40
TFR/Percent
40
36
35
30
30
24
22
21
20
10
15
8
13
6
5
4
3
Second
Middle
Fourth
Richest
0
Poorest
TFR (Children per woman)
CPR (Contraceptive use)
Unmet need for FP
Source: Kenya DHS 2003
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Conclusion
SSA is not on target to meet the MDG on
child mortality
 Arouse attention and commitment on urban
population growth in SSA and the
associated growing urban poverty
 Commitment of APHRC to:

•
•
Improving the well-being of populations through
policy-relevant research on population & health
Key area of work: Clarifying the changing
linkages between urbanization, poverty and
health in SSA
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Thank you
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