This report examines levels and trends in poverty, health status, and use of health services among children under age 5 living in large cities in low- and middle-income countries, and compares their health status and
use of services to those of their other urban, rural, and non-poor counterparts. Twenty-six countries were selected for inclusion; these are the countries with one or more large cities of more than one million
inhabitants in 2014 and that had at least two DHS surveys, one between 1998 and 2004 and a second in or after 2010. Poverty was assessed using the method of unsatisfied basic needs (UBN) to provide comparable
levels in three categories (extremely poor, moderately poor, and not poor). Differentials in levels and decadal trends in 17 health indicators were examined, and the results are shown for individual countries, as
well as for the pooled weighted cross-country averages. On average, across the 26 low- and middle-income countries studied, we estimate that three out of four children under age 5 live in extreme poverty. Poverty is highest in rural areas. About half of children under age 5 who live in large cities are extremely poor, over half in other urban areas, and more than 4 of 5 in rural areas. While extreme poverty has decreased overall and in rural areas, extreme poverty has increased in large cities.
The chances of survival of children under age 5 are greatest in urban areas compared to rural areas. Poor children in large cities and other urban areas have similar chances of survival to age 5. Nutritional status of poor children in large cities is better than in other urban areas, which in turn is better than in rural areas. Both infant and under-five mortality have decreased substantially, with the greatest decadal decline
observed among the extremely poor. Small improvements were made in children’s nutritional status, notably for stunting and anemia. Nutritional status has improved more among the poor than non-poor
children in all areas, including the large cities. The survival gap between the poor and non-poor has narrowed considerably. Similarly, the disadvantage of poor children in stunting and anemia has been
reduced. Among the 12 indicators of health service use in this report, nine show moderate or large differences between the poor and the not poor. The gap between the poor and not poor has narrowed for eight of these
indicators. In large cities, the gap decreased for 10 of the 12 indicators, although the narrowing was small for three indicators.
Overall, there appear to be numerous health advantages to living in an urban area, but these advantages are not conferred to all children. In survival, we see stark disparities across levels of poverty. For all indicators, the urban extremely poor children fare better than their rural extremely poor counterparts, but not as well as non-poor rural children. Despite the narrowing of gaps in many health outcomes between poor and nonpoor and between urban and rural areas, the persistence of poverty and increases in extreme poverty in large cities in low- and middle-income countries remain cause for concern.