Department of Medicine, Boston Medical Center, Boston, MA, USA.
Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.
Trop Med Int Health. 2018 Apr;23(4):433-445. doi: 10.1111/tmi.13043. Epub 2018 Mar 12.
To assess how quality and availability of reproductive, maternal, neonatal (RMNH) services vary by district wealth and urban/rural status in Zambia.
We conducted a retrospective analysis of data from the Millennium Development Goal Acceleration Initiative baseline assessment of 117 health facilities in 9 districts. Quality was assessed through a composite score of 23 individual RMNH indicators, ranging from 0 to 1. Availability was evaluated by density of providers and facilities. Districts were divided into wealth groups based on the multidimensional poverty index (MPI). Relative inequity was calculated using the concentration index for quality indicators (positive favours rich, negative favours poor). Multivariable linear regression was performed for the dependent variable composite quality indicator using MPI, urban/rural, and facility level of care as independent variables.
13 hospitals, 85 health centres and 19 health posts were included. The RMNH composite quality indicator was 0.64. Availability of facilities and providers was universally low. The concentration index for the composite quality indicator was -0.015 [-0.043, 0.013], suggesting no clustering to favour either rich or poor districts. Rich districts had the highest absolute numbers of health facilities and providers, but lowest numbers per facility per 1 000 000 population. Urban districts had slightly better service quality, but not availability. Using regression analysis, only facility level of care was significantly associated with quality outcome.
Composite quality of RMNH services did not vary by district wealth, but was slightly higher in urban districts. The availability data suggest that the higher population in richer districts outpaces health infrastructure.
评估赞比亚各地区的财富水平和城乡状况对生殖、孕产妇和新生儿（RMNH）服务的质量和可及性的影响。
我们对 9 个地区 117 个卫生机构的千年发展目标加速倡议基线评估数据进行了回顾性分析。通过 23 个 RMNH 指标的综合评分来评估质量，评分范围为 0 至 1。通过提供者和设施的密度来评估可用性。根据多维贫困指数（MPI）将地区分为富裕组和贫困组。使用质量指标的集中指数（正偏向富裕，负偏向贫困）来计算相对不公平程度。使用 MPI、城乡和医疗机构级别护理作为自变量，对因变量综合质量指标进行多变量线性回归。
纳入了 13 家医院、85 个卫生中心和 19 个卫生所。RMNH 综合质量指标为 0.64。设施和提供者的可用性普遍较低。综合质量指标的集中指数为-0.015[-0.043，0.013]，表明没有向富裕或贫困地区倾斜的聚类。富裕地区拥有最多的卫生设施和提供者，但每个设施每 100 万人口的数量最少。城市地区的服务质量略高，但可用性较低。使用回归分析，只有医疗机构级别护理与质量结果显著相关。
RMNH 服务的综合质量与地区财富水平无关，但在城市地区略高。可用性数据表明，较富裕地区的较高人口数量超过了卫生基础设施。
