Abstract

Background
Preterm birth, occurring between 20 and 37 weeks of pregnancy, poses a significant global public health challenge. An alarming 15 million babies are born prematurely each year, with over 90% of these occurrences afflicting Low- and Middle-Income Countries (LMICs). Preterm birth rates exhibit regional disparities, ranging from a mere 5% in developed nations to a staggering 18% in LMICs, peaking in Sub-Saharan Africa (SSA). Zambia annually witnesses around 77,600 preterm births. While interventions have targeted rural areas to narrow health disparities, urban areas have often been overlooked. This study seeks to quantify preterm birth distribution in both rural and urban settings, categorized by wealth quintiles, and evaluate disparities to pinpoint and address inequalities. To determine factors associated with preterm births in Zambia.

Methods
This cross-sectional study utilized 2018 Zambia Demographic and Health Survey data, focusing on women aged 15-49 who had given birth within five years before the survey (n=10,962). Employing survey analysis to account for the complex design, equity plots revealed regional and wealth quintile disparities. The survey's logistic regression identified factors associated with preterm births.

Results
Generally, urban areas had higher proportions of preterm birth than rural areas when desegregated by wealth quintile, highest among the poorest. In rural areas, the wealthiest had a higher proportion of preterm births. History of a terminated pregnancy, having ten children or more significantly increased the odds of preterm birth, while attending 4 ANC, and being older than 15-19 years significantly reduced the odds of preterm birth.

Conclusion
This study found that while improvements are seen in the rural areas, the disparities have reversed, and the urban areas are being left behind. The study also reviews that within the rural areas, the wealthiest are being left behind.