Journal of Urban Health-Bulletin of the New York Academy of Medicine最新文献

Identifying and classifying poor and rich groups in cities depends on several factors. Using data from available nationally representative surveys from 38 sub-Saharan African countries, we aimed to identify, through different poverty classifications, the best classification in urban and large city contexts. Additionally, we characterized the poor and rich groups in terms of living standards and schooling. We relied on absolute and relative measures in the identification process. For absolute ones, we selected people living below the poverty line, socioeconomic deprivation status and the UN-Habitat slum definition. We used different cut-off points for relative measures based on wealth distribution: 30%, 40%, 50%, and 60%. We analyzed all these measures according to the absence of electricity, improved drinking water and sanitation facilities, the proportion of children out-of-school, and any household member aged 10 or more with less than 6 years of education. We used the sample size, the gap between the poorest and richest groups, and the observed agreement between absolute and relative measures to identify the best measure. The best classification was based on 40% of the wealth since it has good discriminatory power between groups and median observed agreement higher than 60% in all selected cities. Using this measure, the median prevalence of absence of improved sanitation facilities was 82% among the poorer, and this indicator presented the highest inequalities. Educational indicators presented the lower prevalence and inequalities. Luanda, Ouagadougou, and N'Djaména were considered the worst performers, while Lagos, Douala, and Nairobi were the best performers. The higher the human development index, the lower the observed inequalities. When analyzing cities using nationally representative surveys, we recommend using the relative measure of 40% of wealth to characterize the poorest group. This classification presented large gaps in the selected outcomes and good agreement with absolute measures.

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.

The 'urban penalty' in health refers to the loss of a presumed survival advantage due to adverse consequences of urban life. This study investigated the levels and trends in neonatal, post-neonatal and under-5 mortality rate and key determinants of child survival using data from Tanzania Demographic and Health Surveys (TDHS) (2004/05, 2010 and 2015/16), AIDS Indicator Survey (AIS), Malaria Indicator survey (MIS) and health facility data in Tanzania mainland. We compared Dar es Salaam results with other urban and rural areas in Tanzania mainland, and between the poorest and richest wealth tertiles within Dar es Salaam. Under-5 mortality declined by 41% between TDHS 2004/05 and 2015/2016 from 132 to 78 deaths per 1000 live births, with a greater decline in rural areas compared to Dar es Salaam and other urban areas. Neonatal mortality rate was consistently higher in Dar es Salaam during the same period, with the widest gap (> 50%) between Dar es Salaam and rural areas in TDHS 2015/2016. Coverage of maternal, new-born and child health interventions as well as living conditions were generally better in Dar es Salaam than elsewhere. Within the city, neonatal mortality was 63 and 44 per 1000 live births in the poorest 33% and richest 33%, respectively. The poorest had higher rates of stunting, more overcrowding, inadequate sanitation and lower coverage of institutional deliveries and C-section rate, compared to richest tertile. Children in Dar es Salaam do not have improved survival chances compared to rural children, despite better living conditions and higher coverage of essential health interventions. This urban penalty is higher among children of the poorest households which could only partly be explained by the available indicators of coverage of services and living conditions. Further research is urgently needed to understand the reasons for the urban penalty, including quality of care, health behaviours and environmental conditions.

The physical expansion of the city of Ouagadougou, the capital and largest city of Burkina Faso, subsided in 2015 after the government banned land speculation that contributed to the growth and entrenchment of informal areas. The government subsequently implemented social policies such as free health care for pregnant women and children under 5 years of age. Against this background, we tested the convergence of under-5 mortality trends between formal and informal areas in the city between 2010 and 2019; data covering that period came from the Ouagadougou Health and Demographic Surveillance System (HDSS). The analyses included the calculation of all-cause and cause-specific mortality rates, the implementation of a Poisson regression model, and competing risk models. Over the study period, children in formal areas had lower mortality than those in informal areas. However, the inequality gap decreased over time due to a faster mortality decline in informal areas. This decline was explained by a rapid decline in deaths from malaria and other causes including sepsis, HIV/AIDS, measles, meningitis, and encephalitis. The pursuit of upgrading informal areas and the implementation of social policies targeting the poorest are likely to accelerate the mortality decline in Ouagadougou overall.

As part of an initiative aimed at reducing maternal and child mortality, Senegal implemented a policy of free Cesarean section (C-section) since 2005. Despite the implementation, C-section rates have remained low and significant large disparities in access, particularly in major cities such as Dakar. This paper aims to assess C-section rates and examines socioeconomic inequalities in C-section use in the Dakar region between 2005 and 2019. This study incorporates data from various sources, including the health routine data within District Health Information Software 2 (DHIS2) platform, government statistics on slum areas, and data from Demographic and Health Surveys (DHS). A geospatial analysis was conducted to identify locations of Comprehensive emergency obstetric and Newborn Care (CEmONC) services using the Direction des Travaux Géographiques et Cartographiques (DTGC) databases and satellite imagery from the Google Earth platform. The analytical approach encompassed univariate, bivariate, and multivariate analyses. The C-section rate fluctuated over the years, increasing from 11.1% in 2005 to 16.4% in 2011, declined to 9.8% in 2014, and then raised to 13.3% in 2019. The wealth tertile demonstrated a positive correlation with C-sections in urban areas of the Dakar region. Geospatial analyses revealed that women residing in slum areas were less likely to undergo C-section deliveries. These findings underscore the importance of public health policies extending beyond merely providing free C-section delivery services. Strategies that improve equitable access to C-section delivery services for women across all socioeconomic strata are needed, particularly targeting the poor women and those in urban slums.

The place of residence is a major determinant of RMNCH outcomes, with rural areas often lagging in sub-Saharan Africa. This long-held pattern may be changing given differential progress across areas and increasing urbanization. We assessed inequalities in child mortality and RMNCH coverage across capital cities and other urban and rural areas. We analyzed mortality data from 163 DHS and MICS in 39 countries with the most recent survey conducted between 1990 and 2020 and RMNCH coverage data from 39 countries. We assessed inequality trends in neonatal and under-five mortality and in RMNCH coverage using multilevel linear regression models. Under-five mortality rates and RMNCH service coverage inequalities by place of residence have reduced substantially in sub-Saharan Africa, with rural areas experiencing faster progress than other areas. The absolute gap in child mortality between rural areas and capital cities and that between rural and other urban areas reduced respectively from 41 and 26 deaths per 1000 live births in 2000 to 23 and 15 by 2015. Capital cities are losing their primacy in child survival and RMNCH coverage over other urban areas and rural areas, especially in Eastern Africa where under-five mortality gap between capital cities and rural areas closed almost completely by 2015. While child mortality and RMNCH coverage inequalities are closing rapidly by place of residence, slower trends in capital cities and urban areas suggest gradual erosion of capital city and urban health advantage. Monitoring child mortality and RMNCH coverage trends in urban areas, especially among the urban poor, and addressing factors of within urban inequalities are urgently needed.

In sub-Saharan Africa, urban areas generally have better access to and use of maternal, newborn, and child health (MNCH) services than rural areas, but previous research indicates that there are significant intra-urban disparities. This study aims to investigate temporal trends and geographic differences in maternal, newborn, and child health service utilization between Addis Ababa's poorest and richest districts and households. A World Bank district-based poverty index was used to classify districts into the top 60% (non-poor) and bottom 40% (poor), and wealth index data from the Ethiopian Demographic and Health Survey (EDHS) was used to classify households into the top 60% (non-poor) and bottom 40% (poor). Essential maternal, newborn, and child health service coverage was estimated from routine health facility data for 2019-2021, and five rounds of the EDHS (2000-2019) were used to estimate child mortality. The results showed that service coverage was substantially higher in the top 60% than in the bottom 40% of districts. Coverage of four antenatal care visits, skill birth attendance, and postnatal care all exceeded 90% in the non-poor districts but only ranged from 54 to 67% in the poor districts. Inter-district inequalities were less pronounced for childhood vaccinations, with over 90% coverage levels across all districts. Inter-district inequalities in mortality rates were considerable. The neonatal mortality rate was nearly twice as high in the bottom 40% of households' as in the top 60% of households. Similarly, the under-5 mortality rate was three times higher in the bottom 40% compared to the top 60% of households. The substantial inequalities in MNCH service utilization and child mortality in Addis Ababa highlight the need for greater focus on the city's women and children living in the poorest households and districts in maternal, newborn, and child health programs.

This study investigates the relationship between home mortgages and neighborhood mental health across the 18 largest metropolitan statistical areas (MSAs) in the United States. Home mortgages, a primary avenue to homeownership, contribute to housing security and stability. Moreover, their issuance reflects local investment and potential improvements in the built environment, hypothesized to positively influence community mental well-being. Using census tract-level data from multiple sources, we employed a spatial econometric approach, specifically spatial error modeling, to account for spatial dependency and estimate the association between home mortgage lending (2011 to 2020) and the prevalence of self-reported poor mental health in 2020. Our findings indicate a statistically significant negative association between mortgage issuance and self-reported poor mental health across all 18 MSAs, suggesting that increased mortgage lending is associated with improved neighborhood mental health. Comparisons between standard linear models and spatial error models highlight the influence of unmeasured, spatially correlated factors on neighborhood mental health outcomes. This study underscores mortgage lending as a crucial factor in community well-being and emphasizes the necessity of addressing spatial dependency in neighborhood health studies for accurate estimations. The findings offer valuable insights for researchers and policymakers aiming to enhance community mental health and address health disparities through informed housing policies.

Diabetes is a significant public health concern with significant implications for health equity. Functional disability undermines disease control and may be associated with the relationship between criminal legal involvement and poor chronic disease outcomes, but this relationship has not been studied. This study examined the association between recent criminal legal involvement and functional disability among a nationally representative sample of US adults with diabetes. Adult respondents to the National Survey of Drug Use and Health (2015-2019) who reported a diagnosis of diabetes were included in this analysis examining the association between three forms of recent criminal legal involvement (past year arrest, or supervision on probation or parole) and functional disability, as measured by the World Health Organization Disability Assessment Score 2.0. In multivariate linear regression analyses adjusted for relevant socio-demographic and clinical confounders, the functional disability score increased by 2.7 (95% CI, 1.6-3.9) for those with past year arrest compared to no past year arrest; 1.2 (95% CI, -0.1, 2.6) for those with past year probation compared to no past year probation; and 0.4 (95% CI, -1.1, 1.8) for those with past year parole compared to no past year parole. Recent criminal legal involvement, specifically past year arrest, is associated with greater functional disability, which may serve as an important mediator for poor health outcomes in patients with diabetes. Future research should examine this pathway and prioritize interventions to improve both functional disability and glycemic control among individuals with diabetes and recent criminal legal involvement.