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Abstract：
BACKGROUND: The Health and Social Development Program of the Mopti Region (PADSS2) project, launched in Mali\'s Mopti region, targeted Universal Health Coverage (UHC). The project addressed demand-side barriers by offering an additional subsidy to household contributions, complementing existing State support (component 1). Component 2 focused on supply-side improvements, enhancing quality and coverage. Component 3 strengthened central and decentralised capacity for planning, supervision and UHC reflection, integrating gender mainstreaming. The study assessed the impact of the project on maternal and child healthcare use and explored how rising terrorist activities might affect these health outcomes.
METHODS: The impact of the intervention on assisted births, prenatal care and curative consultations for children under 5 was analysed from January 2016 to December 2021. This was done using an interrupted time series analysis, incorporating a comparison group and spline regression.
RESULTS: C1 increased assisted deliveries by 0.39% (95% CI 0.20 to 0.58] and C2 by 1.52% (95% CI 1.36 to 1.68). C1-enhanced first and fourth antenatal visits by 1.37% (95% CI 1.28 to 1.47) and 2.07% (95% CI 1.86 to 2.28), respectively, while C2 decreased them by 0.53% and 1.16% (95% CI -1.34 to -0.99). For child visits under 5, C1 and C2 showed increases of 0.32% (95% CI 0.20 to 0.43) and 1.36% (95% CI 1.27 to 1.46), respectively. In areas with terrorist attacks, child visits decreased significantly by 24.69% to 39.86% compared with unexposed areas.
CONCLUSIONS: The intervention had a limited impact on maternal and child health, falling short of expectations for a health system initiative. Understanding the varied effects of terrorism on healthcare is key to devising strategies that protect the most vulnerable in the system.
METHODS: The impact of the intervention on assisted births, prenatal care and curative consultations for children under 5 was analysed from January 2016 to December 2021. This was done using an interrupted time series analysis, incorporating a comparison group and spline regression.
RESULTS: C1 increased assisted deliveries by 0.39% (95% CI 0.20 to 0.58] and C2 by 1.52% (95% CI 1.36 to 1.68). C1-enhanced first and fourth antenatal visits by 1.37% (95% CI 1.28 to 1.47) and 2.07% (95% CI 1.86 to 2.28), respectively, while C2 decreased them by 0.53% and 1.16% (95% CI -1.34 to -0.99). For child visits under 5, C1 and C2 showed increases of 0.32% (95% CI 0.20 to 0.43) and 1.36% (95% CI 1.27 to 1.46), respectively. In areas with terrorist attacks, child visits decreased significantly by 24.69% to 39.86% compared with unexposed areas.
CONCLUSIONS: The intervention had a limited impact on maternal and child health, falling short of expectations for a health system initiative. Understanding the varied effects of terrorism on healthcare is key to devising strategies that protect the most vulnerable in the system.
摘要：
背景：Mopti地区的健康和社会发展计划（PADSS2）项目，在马里的Mopti地区发射,有针对性的全民健康覆盖（UHC）。该项目通过为家庭捐款提供额外补贴来解决需求方的障碍，补充现有的国家支助(构成部分1)。第2部分侧重于供应方的改进，提高质量和覆盖面。构成部分3加强了中央和权力下放的规划能力，监督和UHC反映，纳入性别主流。该研究评估了该项目对母婴医疗保健使用的影响，并探讨了不断增加的恐怖活动如何影响这些健康结果。
方法：干预对助产的影响，我们对2016年1月至2021年12月期间5岁以下儿童的产前护理和治疗性咨询进行了分析.这是使用中断的时间序列分析完成的，结合比较组和样条回归。
结果：C1使辅助分娩增加了0.39%（95%CI0.20至0.58），C2增加了1.52%（95%CI1.36至1.68）。C1增加了第一次和第四次产前检查1.37％（95％CI1.28至1.47）和2.07％（95％CI1.86至2.28），分别,而C2分别降低了0.53%和1.16%（95%CI-1.34至-0.99）。对于5岁以下的儿童访视，C1和C2增加了0.32％（95％CI0.20至0.43）和1.36％（95％CI1.27至1.46），分别。在有恐怖袭击的地区，与未暴露地区相比，儿童访视率显着下降了24.69％至39.86％。
结论：干预措施对母婴健康的影响有限，达不到卫生系统倡议的预期。了解恐怖主义对医疗保健的各种影响是制定保护系统中最弱势群体的策略的关键。
方法：干预对助产的影响，我们对2016年1月至2021年12月期间5岁以下儿童的产前护理和治疗性咨询进行了分析.这是使用中断的时间序列分析完成的，结合比较组和样条回归。
结果：C1使辅助分娩增加了0.39%（95%CI0.20至0.58），C2增加了1.52%（95%CI1.36至1.68）。C1增加了第一次和第四次产前检查1.37％（95％CI1.28至1.47）和2.07％（95％CI1.86至2.28），分别,而C2分别降低了0.53%和1.16%（95%CI-1.34至-0.99）。对于5岁以下的儿童访视，C1和C2增加了0.32％（95％CI0.20至0.43）和1.36％（95％CI1.27至1.46），分别。在有恐怖袭击的地区，与未暴露地区相比，儿童访视率显着下降了24.69％至39.86％。
结论：干预措施对母婴健康的影响有限，达不到卫生系统倡议的预期。了解恐怖主义对医疗保健的各种影响是制定保护系统中最弱势群体的策略的关键。
