Abstract：
Living conditions and other factors in urban unplanned settlements present unique challenges for improving maternal and newborn health (MNH), yet MNH inequalities associated with such challenges are not well understood. This study examined trends and inequalities in coverage of MNH services in the last 20 years in unplanned and planned settlements of Lusaka City, Zambia. Geospatial information was used to map Lusaka\'s settlements and health facilities. Zambia Demographic Health Surveys (ZDHS 2001, 2007, 2013/2014, and 2018) were used to compare antenatal care (ANC), institutional delivery, and Cesarean section (C-section) coverage, and neonatal mortality rates between the poorer 60% and richer 40% households. Health Management Information System (HMIS) data from 2018 to 2021 were used to compute service volumes and coverage rates for ANC1 and ANC4, and institutional delivery and C-sections by facility level and type in planned and unplanned settlements. Although the correlation is not exact, our data analysis showed close alignment; and thus, we opted to use the 60% poorer and 40% richer groups as a proxy for households in unplanned versus planned settlements. Unplanned settlements were serviced by primary centers or first-level hospitals. ZDHS findings show that by 2018, at least one ANC visit and institutional delivery became nearly universal throughout Lusaka, but early and four or more ANC visits, C-sections, and neonatal mortality rates remained worse among poorer than richer women in ZDHS. In HMIS, ANC and institutional delivery volumes were highest in public facilities, especially in unplanned settlements. The volume of C-sections was much greater within facilities in planned than unplanned settlements. Our study exposed persistent gaps in timing and use of ANC and emergency obstetric care between unplanned and planned communities. Closing such gaps requires strengthening outreach early and consistently in pregnancy and increasing emergency obstetric care capacities and referrals to improve access to important MNH services for women and newborns in Lusaka\'s unplanned settlements.
摘要：
城市计划外居住区的生活条件和其他因素对改善孕产妇和新生儿健康(MNH)提出了独特的挑战。然而，与这些挑战相关的MNH不平等还没有得到很好的理解。这项研究调查了过去20年卢萨卡市计划外和计划外定居点MNH服务覆盖面的趋势和不平等，赞比亚。地理空间信息用于绘制卢萨卡定居点和卫生设施的地图。赞比亚人口健康调查（ZDHS2001、2007、2013/2014和2018）用于比较产前护理（ANC），机构交付，和剖腹产(剖腹产)保险，较贫穷的60%家庭和较富裕的40%家庭之间的新生儿死亡率。2018年至2021年的健康管理信息系统（HMIS）数据用于计算ANC1和ANC4的服务量和覆盖率，以及计划内和计划外定居点按设施级别和类型划分的机构交付和剖腹产。虽然相关性并不确切,我们的数据分析显示出密切的一致性；因此，我们选择使用60％的贫困和40％的富裕群体作为计划外定居点与计划定居点中家庭的代表。计划外的定居点由初级中心或一级医院提供服务。ZDHS的调查结果显示，到2018年，至少有一次非国大访问和机构服务在整个卢萨卡几乎普及，但是早期和四次或更多的非国大访问，C-sects,在ZDHS中，较贫穷的妇女比富裕的妇女的新生儿死亡率仍然更差。在HMIS,非国大和机构交付量最高的是公共设施，特别是在计划外的定居点。在计划的设施内，剖腹产的数量比计划外的定居点大得多。我们的研究暴露了计划外社区和计划社区之间在ANC和紧急产科护理的时间和使用方面的持续差距。缩小这种差距需要在怀孕期间尽早和持续地加强外联，并增加紧急产科护理能力和转诊，以改善卢萨卡计划外定居点的妇女和新生儿获得重要的MNH服务的机会。
