Predictors of Hospitalization During the First Year of Life among 31 999 Tanzanian Infants

Objective: This study explored the risk factors for infant hospitalization in urban and peri-urban/rural Tanzania. Methods: We conducted a prospective cohort study examining predictors of hospitalization during the first year of life among infants enrolled at birth in a large randomized controlled trial of neonatal vitamin A supplementation conducted in urban Dar es Salaam (n = 11 895) and peri-urban/rural Morogoro region (n = 20 104) in Tanzania. Demographic, socioeconomic, environmental and birth outcome predictors of hospitalization were assessed using proportional hazard models. Results: The rate of hospitalization was highest during the neonatal period in both Dar es Salaam (102/10 000 neonatal-months) and Morogoro region (78/10 000 neonatal-months). Hospitalization declined with increased age and was lowest for infants 6-12 months of age in both Dar es Salaam (11/10 000 infant-months) and Morogoro region (16/10 000 infant-months). In both Dar es Salaam and Morogoro region, older maternal age, male sex, low birth weight and being small for gestational age were significant predictors of higher risk of hospitalization (p<0.05). Increased wealth and having a flush toilet were significantly associated with an increased risk of hospitalization in Morogoro region only (p<0.05). Conclusions: This study determined high rates of neonatal hospitalization in Tanzania. Interventions to increase birth size may decrease risk of hospitalization. Equity in access to hospitals for poor rural families in Tanzania requires attention.