PDF(Pubmed)
Abstract：
Women and children bear a substantial burden of morbidity and mortality due to armed conflict. Life-saving maternal and child health (MCH) services are low-quality in most conflict-affected regions. Previous studies on armed conflict and MCH services have been mostly cross-sectional, and a causal relationship between armed conflict and MCH services utilisation cannot be inferred.
First, we constructed a utility equation for maternal health-seeking behaviour. Next, we extracted MCH data from the Multiple Indicator Cluster Survey led by the UNICEF. Armed conflict data were obtained from the Uppsala Conflict Data Programme; 55 683 women aged 15-49 from Chad, the Central African Republic, the Democratic Republic of Congo (DRC) and the Republic of Iraq were selected as participants. We fitted a difference-in-differences (DID) model, taking before or after the conflict started as an exposure variable to estimate the effects of armed conflict on maternal health-seeking behaviours.
According to the results of the DID model, in the regional sample, armed conflict had a positive effect on tetanus vaccination (β=0.055, 95% CI 0.004 to 0.106, p<0.05), and had a negative effect on antenatal care at least eight visits (ANC8+) (β=-0.046, 95% CI -0.078 to -0.015, p<0.01). And, the effects of armed conflict on ANC, ANC4+, institutional delivery and early initiation of breast feeding (EIB) were not statistically significant. As for the country sample, we found that armed conflict had a negative effect on EIB (β=-0.085, 95% CI -0.184 to 0.015, p<0.1) in Chad. In Iraq, armed conflict had positive impacts on ANC (β=0.038, 95% CI -0.001 to 0.078, p<0.1) and tetanus vaccination (β=0.059, 95% CI 0.012 to 0.107, p<0.05), whereas it had a negative effect on ANC8+ (β=-0.039, 95% CI -0.080 to 0.002, p<0.1). No statistically significant associations were discovered in DRC based on the DID model.
There might be a mixed effect of armed conflict on maternal health-seeking behaviours. In the absence of humanitarian assistance, armed conflict reduces certain maternal health-seeking behaviours, such as ANC8+. When practical humanitarian health assistance is provided, the damage can be alleviated, and even the prevalence of maternal health-seeking behaviours can be improved, such as tetanus vaccination. Providing humanitarian assistance to conflict-affected regions improved the accessibility of MCH services for women living in those areas. However, the goals of saving lives and alleviating suffering still need to be achieved. In conflict-affected regions, humanitarian assistance on ANC, institutional delivery and breast feeding need strengthening.
First, we constructed a utility equation for maternal health-seeking behaviour. Next, we extracted MCH data from the Multiple Indicator Cluster Survey led by the UNICEF. Armed conflict data were obtained from the Uppsala Conflict Data Programme; 55 683 women aged 15-49 from Chad, the Central African Republic, the Democratic Republic of Congo (DRC) and the Republic of Iraq were selected as participants. We fitted a difference-in-differences (DID) model, taking before or after the conflict started as an exposure variable to estimate the effects of armed conflict on maternal health-seeking behaviours.
According to the results of the DID model, in the regional sample, armed conflict had a positive effect on tetanus vaccination (β=0.055, 95% CI 0.004 to 0.106, p<0.05), and had a negative effect on antenatal care at least eight visits (ANC8+) (β=-0.046, 95% CI -0.078 to -0.015, p<0.01). And, the effects of armed conflict on ANC, ANC4+, institutional delivery and early initiation of breast feeding (EIB) were not statistically significant. As for the country sample, we found that armed conflict had a negative effect on EIB (β=-0.085, 95% CI -0.184 to 0.015, p<0.1) in Chad. In Iraq, armed conflict had positive impacts on ANC (β=0.038, 95% CI -0.001 to 0.078, p<0.1) and tetanus vaccination (β=0.059, 95% CI 0.012 to 0.107, p<0.05), whereas it had a negative effect on ANC8+ (β=-0.039, 95% CI -0.080 to 0.002, p<0.1). No statistically significant associations were discovered in DRC based on the DID model.
There might be a mixed effect of armed conflict on maternal health-seeking behaviours. In the absence of humanitarian assistance, armed conflict reduces certain maternal health-seeking behaviours, such as ANC8+. When practical humanitarian health assistance is provided, the damage can be alleviated, and even the prevalence of maternal health-seeking behaviours can be improved, such as tetanus vaccination. Providing humanitarian assistance to conflict-affected regions improved the accessibility of MCH services for women living in those areas. However, the goals of saving lives and alleviating suffering still need to be achieved. In conflict-affected regions, humanitarian assistance on ANC, institutional delivery and breast feeding need strengthening.
摘要：
背景：由于武装冲突，妇女和儿童承受着巨大的发病率和死亡率负担。在大多数受冲突影响的地区，挽救生命的妇幼保健（MCH）服务的质量很低。以前关于武装冲突和妇幼保健服务的研究大多是横向研究，武装冲突与妇幼保健服务利用之间的因果关系无法推断。
方法：首先，我们构建了孕产妇寻求健康行为的效用方程。接下来,我们从联合国儿童基金会领导的多指标类集调查中提取了MCH数据。武装冲突数据来自乌普萨拉冲突数据方案；来自乍得的55683名15-49岁妇女，中非共和国,刚果民主共和国（DRC）和伊拉克共和国被选为参与者。我们拟合了差异差异(DID)模型，将冲突开始之前或之后作为暴露变量，以估计武装冲突对孕产妇寻求健康行为的影响。
结果：根据DID模型的结果，在区域样本中，武装冲突对破伤风疫苗接种有积极影响(β=0.055，95%CI0.004至0.106，p<0.05)，至少8次访视(ANC8+)对产前护理有负面影响(β=-0.046,95%CI-0.078至-0.015,p<0.01)。And,武装冲突对非国大的影响，ANC4+,机构分娩和早期开始母乳喂养(EIB)无统计学意义.至于国家样本，我们发现武装冲突对乍得的EIB有负面影响（β=-0.085，95％CI-0.184至0.015，p<0.1）。在伊拉克,武装冲突对ANC(β=0.038，95%CI-0.001至0.078，p<0.1)和破伤风疫苗接种(β=0.059，95%CI0.012至0.107，p<0.05)有积极影响，而对ANC8+有负面影响(β=-0.039，95%CI-0.080至0.002，p<0.1)。根据DID模型，在DRC中未发现统计学上显着的关联。
结论：武装冲突可能对孕产妇寻求健康的行为产生混合影响。在没有人道主义援助的情况下，武装冲突减少了某些寻求孕产妇健康的行为，如ANC8+。当提供实际的人道主义卫生援助时，可以减轻损害，甚至可以改善孕产妇寻求健康行为的患病率，如破伤风疫苗接种。向受冲突影响地区提供人道主义援助改善了生活在这些地区的妇女获得妇幼保健服务的机会。然而,拯救生命和减轻痛苦的目标仍然需要实现。在受冲突影响的地区，对非国大的人道主义援助,机构分娩和母乳喂养需要加强。
方法：首先，我们构建了孕产妇寻求健康行为的效用方程。接下来,我们从联合国儿童基金会领导的多指标类集调查中提取了MCH数据。武装冲突数据来自乌普萨拉冲突数据方案；来自乍得的55683名15-49岁妇女，中非共和国,刚果民主共和国（DRC）和伊拉克共和国被选为参与者。我们拟合了差异差异(DID)模型，将冲突开始之前或之后作为暴露变量，以估计武装冲突对孕产妇寻求健康行为的影响。
结果：根据DID模型的结果，在区域样本中，武装冲突对破伤风疫苗接种有积极影响(β=0.055，95%CI0.004至0.106，p<0.05)，至少8次访视(ANC8+)对产前护理有负面影响(β=-0.046,95%CI-0.078至-0.015,p<0.01)。And,武装冲突对非国大的影响，ANC4+,机构分娩和早期开始母乳喂养(EIB)无统计学意义.至于国家样本，我们发现武装冲突对乍得的EIB有负面影响（β=-0.085，95％CI-0.184至0.015，p<0.1）。在伊拉克,武装冲突对ANC(β=0.038，95%CI-0.001至0.078，p<0.1)和破伤风疫苗接种(β=0.059，95%CI0.012至0.107，p<0.05)有积极影响，而对ANC8+有负面影响(β=-0.039，95%CI-0.080至0.002，p<0.1)。根据DID模型，在DRC中未发现统计学上显着的关联。
结论：武装冲突可能对孕产妇寻求健康的行为产生混合影响。在没有人道主义援助的情况下，武装冲突减少了某些寻求孕产妇健康的行为，如ANC8+。当提供实际的人道主义卫生援助时，可以减轻损害，甚至可以改善孕产妇寻求健康行为的患病率，如破伤风疫苗接种。向受冲突影响地区提供人道主义援助改善了生活在这些地区的妇女获得妇幼保健服务的机会。然而,拯救生命和减轻痛苦的目标仍然需要实现。在受冲突影响的地区，对非国大的人道主义援助,机构分娩和母乳喂养需要加强。
