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Armed conflicts and national trends in reproductive, maternal, newborn and child health in sub-Saharan Africa: what can national health surveys tell us?
  1. Ties Boerma1,
  2. Hannah Tappis2,
  3. Ghada Saad-Haddad3,
  4. Jai Das4,
  5. Dessalegn Y Melesse5,
  6. Jocelyn DeJong3,
  7. Paul Spiegel6,
  8. Robert Black7,
  9. Cesar Victora8,
  10. Zulfiqar A Bhutta9,
  11. Aluisio J D Barros10
  1. 1 Center for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
  2. 2 Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3 Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  4. 4 Faculty of Health Sciences, Aga Khan University, Karachi, Pakistan
  5. 5 Community Health Science, University of Manitoba, Winnipeg, Manitoba, Canada
  6. 6 International Health, Bloomberg School of Public Health, Johns Hopkins Unversity, Baltimore, Maryland, USA
  7. 7 International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
  8. 8 Epidemiology, Federal University of Pelotas, Pelotas, Brazil
  9. 9 Hospital for Sick Children, Toronto, Ontario, Canada
  10. 10 International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
  1. Correspondence to Dr Ties Boerma; Ties.Boerma{at}umanitoba.ca

Abstract

Armed conflicts are widespread in sub-Saharan Africa and considered to be an important factor in slowing down national progress in reproductive, maternal, newborn and child health (RMNCH). The measurement of the impact of conflicts on national levels and trends in RMNCH is difficult. National surveys conducted before and sometimes during and after conflicts are a major source of information on the national and local effects of conflicts on RMNCH. We examined data from national surveys in 13 countries in sub-Saharan Africa with major conflicts during 1990–2016 to assess the levels and trends in RMNCH intervention coverage, nutritional status and mortality in children under 5 years in comparison with subregional trends. The surveys provide substantive evidence of a negative association between levels and trends in national indicators of RMNCH service coverage, child growth and under-5 mortality with armed conflict, with some notable exceptions. National surveys are an important source of data to assess the longer term national consequences of conflicts for RMNCH in most countries, despite limitations due to sampling and timing of the surveys.

  • reproductive health
  • maternal newborn and child health
  • armed conflict
  • household surveys
  • Africa
  • child mortality
  • child growth
  • coverage of interventions

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/bmjgh-2018-001300

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors TB conceptualised the paper and wrote the first draft. All authors contributed to multiple revisions. AJDB and CV conducted the analyses of the survey data to provide estimates of coverage. DYM led the estimation work for comparative analyses.

    • Funding This work was supported by a grant of the Bill and Melinda Gates Foundation to the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data are available in the public domain.

    • Author note This paper is part of a supplement that aims to address the challenges in measurement and monitoring women’s, children’s and adolescents’ health in the context of the sustainable development goals. The series includes improved ways to measure and monitor inequalities, drivers of women’s, children’s and adolescents’ health especially governance, early childhood development, reproductive maternal and child health in conflict settings, nutrition intervention coverage, and effective coverage of interventions. These papers were developed as part of an initiative of the multi-institutional Countdown to 2030 for women’s, children’s and adolescents’ health, presented at a Countdown measurement conference in 31 January to 1 February 2018 in South Africa, and benefited from reviews by members of the Countdown working groups.