Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019.

<h4>Background</h4>Armed conflicts have major indirect health impacts in addition to the direct harms from violence. They create enduring political instability, destabilise health systems, and foster negative socioeconomic and environmental conditions-all of which constrain efforts to re...

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Autores principales:	Mohammed Jawad, Thomas Hone, Eszter P Vamos, Valeria Cetorelli, Christopher Millett
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/688f011b908a4a8cb50e05f3306319ff
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spelling	oai:doaj.org-article:688f011b908a4a8cb50e05f3306319ff2021-12-02T19:55:45ZImplications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019.1549-12771549-167610.1371/journal.pmed.1003810https://doaj.org/article/688f011b908a4a8cb50e05f3306319ff2021-09-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1003810https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Armed conflicts have major indirect health impacts in addition to the direct harms from violence. They create enduring political instability, destabilise health systems, and foster negative socioeconomic and environmental conditions-all of which constrain efforts to reduce maternal and child mortality. The detrimental impacts of conflict on global maternal and child health are not robustly quantified. This study assesses the association between conflict and maternal and child health globally.<h4>Methods and findings</h4>Data for 181 countries (2000-2019) from the Uppsala Conflict Data Program and World Bank were analysed using panel regression models. Primary outcomes were maternal, under-5, infant, and neonatal mortality rates. Secondary outcomes were delivery by a skilled birth attendant and diphtheria, pertussis, and tetanus (DPT) and measles vaccination coverage. Models were adjusted for 10 confounders, country and year fixed effects, and conflict lagged by 1 year. Further lagged associations up to 10 years post-conflict were tested. The number of excess deaths due to conflict was estimated. Out of 3,718 country-year observations, 522 (14.0%) had minor conflicts and 148 (4.0%) had wars. In adjusted models, conflicts classified as wars were associated with an increase in maternal mortality of 36.9 maternal deaths per 100,000 live births (95% CI 1.9-72.0; 0.3 million excess deaths [95% CI 0.2 million-0.4 million] over the study period), an increase in infant mortality of 2.8 per 1,000 live births (95% CI 0.1-5.5; 2.0 million excess deaths [95% CI 1.6 million-2.5 million]), a decrease in DPT vaccination coverage of 4.9% (95% CI 1.5%-8.3%), and a decrease in measles vaccination coverage of 7.3% (95% CI 2.7%-11.8%). The long-term impacts of war were demonstrated by associated increases in maternal mortality observed for up to 7 years, in under-5 mortality for 3-5 years, in infant mortality for up to 8 years, in DPT vaccination coverage for up to 3 years, and in measles vaccination coverage for up to 2 years. No evidence of association between armed conflict and neonatal mortality or delivery by a skilled birth attendant was found. Study limitations include the ecological study design, which may mask sub-national variation in conflict intensity, and the quality of the underlying data.<h4>Conclusions</h4>Our analysis indicates that armed conflict is associated with substantial and persistent excess maternal and child deaths globally, and with reductions in key measures that indicate reduced availability of organised healthcare. These findings highlight the importance of protecting women and children from the indirect harms of conflict, including those relating to health system deterioration and worsening socioeconomic conditions.Mohammed JawadThomas HoneEszter P VamosValeria CetorelliChristopher MillettPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 9, p e1003810 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Mohammed Jawad Thomas Hone Eszter P Vamos Valeria Cetorelli Christopher Millett Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019.
description	<h4>Background</h4>Armed conflicts have major indirect health impacts in addition to the direct harms from violence. They create enduring political instability, destabilise health systems, and foster negative socioeconomic and environmental conditions-all of which constrain efforts to reduce maternal and child mortality. The detrimental impacts of conflict on global maternal and child health are not robustly quantified. This study assesses the association between conflict and maternal and child health globally.<h4>Methods and findings</h4>Data for 181 countries (2000-2019) from the Uppsala Conflict Data Program and World Bank were analysed using panel regression models. Primary outcomes were maternal, under-5, infant, and neonatal mortality rates. Secondary outcomes were delivery by a skilled birth attendant and diphtheria, pertussis, and tetanus (DPT) and measles vaccination coverage. Models were adjusted for 10 confounders, country and year fixed effects, and conflict lagged by 1 year. Further lagged associations up to 10 years post-conflict were tested. The number of excess deaths due to conflict was estimated. Out of 3,718 country-year observations, 522 (14.0%) had minor conflicts and 148 (4.0%) had wars. In adjusted models, conflicts classified as wars were associated with an increase in maternal mortality of 36.9 maternal deaths per 100,000 live births (95% CI 1.9-72.0; 0.3 million excess deaths [95% CI 0.2 million-0.4 million] over the study period), an increase in infant mortality of 2.8 per 1,000 live births (95% CI 0.1-5.5; 2.0 million excess deaths [95% CI 1.6 million-2.5 million]), a decrease in DPT vaccination coverage of 4.9% (95% CI 1.5%-8.3%), and a decrease in measles vaccination coverage of 7.3% (95% CI 2.7%-11.8%). The long-term impacts of war were demonstrated by associated increases in maternal mortality observed for up to 7 years, in under-5 mortality for 3-5 years, in infant mortality for up to 8 years, in DPT vaccination coverage for up to 3 years, and in measles vaccination coverage for up to 2 years. No evidence of association between armed conflict and neonatal mortality or delivery by a skilled birth attendant was found. Study limitations include the ecological study design, which may mask sub-national variation in conflict intensity, and the quality of the underlying data.<h4>Conclusions</h4>Our analysis indicates that armed conflict is associated with substantial and persistent excess maternal and child deaths globally, and with reductions in key measures that indicate reduced availability of organised healthcare. These findings highlight the importance of protecting women and children from the indirect harms of conflict, including those relating to health system deterioration and worsening socioeconomic conditions.
format	article
author	Mohammed Jawad Thomas Hone Eszter P Vamos Valeria Cetorelli Christopher Millett
author_facet	Mohammed Jawad Thomas Hone Eszter P Vamos Valeria Cetorelli Christopher Millett
author_sort	Mohammed Jawad
title	Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019.
title_short	Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019.
title_full	Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019.
title_fullStr	Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019.
title_full_unstemmed	Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019.
title_sort	implications of armed conflict for maternal and child health: a regression analysis of data from 181 countries for 2000-2019.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/688f011b908a4a8cb50e05f3306319ff
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Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019.

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