Inequalities in place of death between formal and informal settlements in Ouagadougou

Rapid and unplanned urbanization in Sub-Saharan Africa has led to the expansion of informal settlements, raising concerns about intra-urban health inequalities. While disparities in access to healthcare are well documented, less is known about how these inequalities shape place of death, a key proxy for healthcare utilization at the end of life. This study uses longitudinal data from the Ouagadougou Health and Demographic Surveillance System (HDSS) collected between 2009 and 2021. We analyzed 1,169 deaths among children under five and 2,930 deaths among individuals aged 15 years and older. Logistic regression models were used to assess the association between settlement type (Formal vs. Informal) and the likelihood of dying in health facilities, controlling for socio-demographic characteristics, household socio-economic status, and causes of death. Overall, a higher proportion of deaths occurred in health facilities among children (64.07%) than among adults (46.35%). Among children, settlement type was not significantly associated with place of death. In contrast, adults living in informal settlements were significantly less likely to die in health facilities compared to those in formal settlements. Socio-economic factors were strongly associated with place of death in both groups, with household wealth associated with facility death among children, and both education and household wealth associated with facility death among adults. Older adults and individuals dying from chronic conditions were more likely to die at home. These findings highlight important intra-urban inequalities in access to healthcare at the end of life, particularly among adults. While the absence of differences among children may be consistent with policies targeting maternal and child health, significant gaps persist for adults and the elderly. Addressing these inequalities requires expanding access to healthcare services in informal settlements and strengthening specialized care for chronic conditions in peripheral areas of African cities. Not applicable.