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Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival. BMJ global health Akseer, N., Wright, J., Tasic, H., Everett, K., Scudder, E., Amsalu, R., Boerma, T., Bendavid, E., Kamali, M., Barros, A. J., da Silva, I. C., Bhutta, Z. A. 2020; 5 (1): e002214

Abstract

Introduction: Conflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, maternal, newborn and child health interventions between conflict and non-conflict low-income and middle-income countries (LMICs).Methods: We carried out a time-series multicountry ecological study using data for 137 LMICs between 1990 and 2017, as defined by the 2019 World Bank classification. The data set covers approximately 3.8million surveyed mothers (15-49 years) and 1.1million children under 5 years including newborns (<1month), young children (1-59 months) and school-aged children and adolescents (5-14 years). Outcomes include annual maternal and child mortality rates and coverage (%) of family planning services, 1+antenatalcare visit, skilled attendant at birth (SBA), exclusive breast feeding (0-5 months), early initiation of breast feeding (within 1hour), neonatal protection against tetanus, newborn postnatal care within 2days, 3 doses of diphtheria, pertussis and tetanus vaccine, measles vaccination, and careseeking for pneumonia and diarrhoea.Results: Conflict countries had consistently higher maternal and child mortality rates than non-conflict countries since 1990 and these gaps persist despite rates continually declining for both groups. Access to essential reproductive and maternal health services for poorer, less educated and rural-based families was several folds worse in conflict versus non-conflict countries.Conclusions: Inequalities in coverage of reproductive/maternal health and child vaccine interventions are significantly worse in conflict-affected countries. Efforts to protect maternal and child health interventions in conflict settings should target the most disadvantaged families including the poorest, least educated and those living in rural areas.

View details for DOI 10.1136/bmjgh-2019-002214

View details for PubMedID 32133179