Background: Improvements in child survival have been very poor in sub-Saharan Africa (SSA).
Since the 1990s, declines in child mortality have reversed in many countries in the region, while in
others, they have either slowed or stalled, making it improbable that the target of reducing child
mortality by two thirds by 2015 will be reached. This paper highlights the implications of urban
population growth and access to health and social services on progress in achieving MDG 4.
Specifically, it examines trends in childhood mortality in SSA in relation to urban population growth,
vaccination coverage and access to safe drinking water.
Methods: Correlation methods are used to analyze national-level data from the Demographic and
Health Surveys and from the United Nations. The analysis is complemented by case studies on
intra-urban health differences in Kenya and Zambia.
Results: Only five of the 22 countries included in the study have recorded declines in urban child
mortality that are in line with the MDG target of about 4% per year; five others have recorded an
increase; and the 12 remaining countries witnessed only minimal decline. More rapid rate of urban
population growth is associated with negative trend in access to safe drinking water and in
vaccination coverage, and ultimately to increasing or timid declines in child mortality. There is
evidence of intra-urban disparities in child health in some countries like Kenya and Zambia.
Conclusion: Failing to appropriately target the growing sub-group of the urban poor and improve
their living conditions and health status – which is an MDG target itself – may result in lack of
improvement on national indicators of health. Sustained expansion of potable water supplies and
vaccination coverage among the disadvantaged urban dwellers should be given priority in the efforts
to achieve the child mortality MDG in SSA.