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Zampas C, Brown R, Afulukwe O. Interpreting International Humanitarian Law to Guarantee Abortion and Other Sexual and Reproductive Health Services in Armed Conflict. Health Hum Rights 2024; 26:31-44. [PMID: 38933223 PMCID: PMC11197860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
The provision of basic sexual and reproductive health services in humanitarian settings, including armed conflict, is extremely limited, causing preventable mortalities and morbidities and violating human rights. Over 50% of all maternal deaths occur in humanitarian and fragile settings. International humanitarian law falls short in guaranteeing access to the full range of sexual and reproductive health information and services for all persons. Guaranteeing access to sexual and reproductive health services under international humanitarian law can increase access to services, improving the health and well-being of civilians in conflict zones. This paper sets forth ways in which international human rights law on sexual and reproductive health and rights should be incorporated into the forthcoming International Committee of the Red Cross Commentary on Geneva Convention IV, regarding the protection of civilians, to ensure services in the context of armed conflict.
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Affiliation(s)
- Christina Zampas
- Fellow at the International Reproductive and Sexual Health Law Program, Faculty of Law, University of Toronto, Canada
| | - Rebecca Brown
- Senior regional director of global advocacy at the Center for Reproductive Rights, New York, United States
| | - Onyema Afulukwe
- Associate director for new initiatives and business development at the Center for Reproductive Rights, New York, United States
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Hone T, Gonçalves J, Seferidi P, Moreno-Serra R, Rocha R, Gupta I, Bhardwaj V, Hidayat T, Cai C, Suhrcke M, Millett C. Progress towards universal health coverage and inequalities in infant mortality: an analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019. Lancet Glob Health 2024; 12:e744-e755. [PMID: 38614628 DOI: 10.1016/s2214-109x(24)00040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Expanding universal health coverage (UHC) might not be inherently beneficial to poorer populations without the explicit targeting and prioritising of low-income populations. This study examines whether the expansion of UHC between 2000 and 2019 is associated with reduced socioeconomic inequalities in infant mortality in low-income and middle-income countries (LMICs). METHODS We did a retrospective analysis of birth data compiled from Demographic and Health Surveys (DHSs). We analysed all births between 2000 and 2019 from all DHSs available for this period. The primary outcome was infant mortality, defined as death within 1 year of birth. Logistic regression models with country and year fixed effects assessed associations between country-level progress to UHC (using WHO's UHC service coverage index) and infant mortality (overall and by wealth quintile), adjusting for infant-level, mother-level, and country-level variables. FINDINGS A total of 4 065 868 births to 1 833 011 mothers were analysed from 177 DHSs covering 60 LMICs between 2000 and 2019. A one unit increase in the UHC index was associated with a 1·2% reduction in the risk of infant death (AOR 0·988, 95% CI 0·981-0·995; absolute measure of association, 0·57 deaths per 1000 livebirths). An estimated 15·5 million infant deaths were averted between 2000 and 2019 because of increases in UHC. However, richer wealth quintiles had larger associated reductions in infant mortality from UHC (quintile 5 AOR 0·983, 95% CI 0·973-0·993) than poorer quintiles (quintile 1 0·991, 0·985-0·998). In the early stages of UHC, UHC expansion was generally beneficial to poorer populations (ie, larger reductions in infant mortality for poorer households [infant deaths per 1000 per one unit increase in UHC coverage: quintile 1 0·84 vs quintile 5 0·59]), but became less so as overall coverage increased (quintile 1 0·64 vs quintile 5 0·57). INTERPRETATION Since UHC expansion in LMICs appears to become less beneficial to poorer populations as coverage increases, UHC policies should be explicitly designed to ensure lower income groups continue to benefit as coverage expands. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil.
| | - Judite Gonçalves
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Paraskevi Seferidi
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | | | - Rudi Rocha
- Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil; São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Indrani Gupta
- Institute of Economic Growth, University of Delhi, Delhi, India
| | - Vinayak Bhardwaj
- South African Medical Research Council and Wits Centre for Health Economics and Decision Science, PRICELESS South Africa, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Taufik Hidayat
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia; Department of Economics, University of Sussex, Brighton, UK
| | - Chang Cai
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, Heslington, York, UK; Luxembourg Institute of Socio-economic Research, Esch-sur-Alzette, Luxembourg
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
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Shafiq Y, Rubini E, Fazal ZZ, Bukhari MM, Zakaria M, Zeeshan NUH, Muhammad A, Ragazzoni L, Barone-Adesi F, Valente M. Impact of Ebola and COVID-19 on maternal, neonatal, and child health care among populations affected by conflicts: a scoping review exploring demand and supply-side barriers and solutions. Confl Health 2024; 18:12. [PMID: 38291492 PMCID: PMC10829480 DOI: 10.1186/s13031-024-00572-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Armed conflicts have a severe impact on the health of women and children. Global health emergencies such as pandemics and disease outbreaks further exacerbate the challenges faced by vulnerable populations in accessing maternal, neonatal, and child healthcare (MNCH). There is a lack of evidence that summarizes the challenges faced by conflict-affected pregnant women, mothers, and children in accessing MNCH services during global health emergencies, mainly the Ebola and COVID-19 pandemics. This scoping review aimed to analyze studies evaluating and addressing barriers to accessing comprehensive MNCH services during Ebola and COVID-19 emergencies in populations affected by conflict. METHODS The search was conducted on PubMed, Scopus, and Web of Science databases using terms related to Ebola and COVID-19, conflicts, and MNCH. Original studies published between 1990 and 2022 were retrieved. Articles addressing the challenges in accessing MNCH-related services during pandemics in conflict-affected settings were included. Thematic analysis was performed to categorize the findings and identify barriers and solutions. RESULTS Twenty-nine studies met the inclusion criteria. Challenges were identified in various MNCH domains, including antenatal care, intrapartum care, postnatal care, vaccination, family planning, and the management of childhood illnesses. Ebola-related supply-side challenges mainly concerned accessibility issues, health workforce constraints, and the adoption of stringent protocols. COVID-19 has resulted in barriers related to access to care, challenges pertaining to the health workforce, and new service adoption. On the demand-side, Ebola- and COVID-19-related risks and apprehensions were the leading barriers in accessing MNCH care. Community constraints on utilizing services during Ebola were caused by a lack of trust and awareness. Demand-side challenges of COVID-19 included fear of disease, language barriers, and communication difficulties. Strategies such as partnerships, strengthening of health systems, service innovation, and community-based initiatives have been employed to overcome these barriers. CONCLUSION Global health emergencies amplify the barriers to accessing MNCH services faced by conflict-affected populations. Cultural, linguistic, and supply-side factors are key challenges affecting various MNCH domains. Community-sensitive initiatives enhancing primary health care (PHC), mobile clinics, or outreach programs, and the integration of MNCH into PHC delivery should be implemented. Efforts should prioritize the well-being and empowerment of vulnerable populations. Addressing these barriers is crucial for achieving universal health coverage and the Sustainable Development Goals.
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Affiliation(s)
- Yasir Shafiq
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy.
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
- Centre of Excellence for Trauma and Emergencies (CETE) & Community Health Science, The Aga Khan University, Karachi, Pakistan.
- Harvard Humanitarian Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Bostan, USA.
- Department of Pediatrics, Brigham and Women's Hospital, Global Advancement of Infants and Mothers, Boston, USA.
| | - Elena Rubini
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | | | | | | | | | | | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Francesco Barone-Adesi
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
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Ajike SO, Oloyede BL. Determinants of child survival practice among caregivers in internally displaced persons' camps in Abuja Municipal Area Council, Nigeria. Child Care Health Dev 2024; 50:e13201. [PMID: 37950536 DOI: 10.1111/cch.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/23/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Child survival remains a major public health challenge in the sub-Saharan region of Africa, especially Nigeria. The Boko Haram crisis, which has aggravated this, has led to the displacement of many people in the north-eastern region, including children under five. This study investigated the determinants of child survival practice among caregivers in internally displaced persons' (IDP) camps in Abuja Municipal Area Council (AMAC), Nigeria. METHODOLOGY A cross-sectional design was used to collect data on determinants of child survival practice from 312 caregivers in five purposively selected IDP camps in AMAC using the snowball sampling technique. Data were analysed using univariate, bivariate, and multivariate statistics at 5% level of significance. RESULTS The mean age of respondents was 29.6 ± 6.72 years. There was a significant (p < 0.05) relationship between the predisposing, reinforcing, enabling and environmental factors studied and child survival practice. Findings also indicated that all factors were significant (p < 0.05) predictors of child survival practice with the reinforcing factor being the major predictor (ß = 0.38; t = 6.08). CONCLUSION Attention needs to be paid to all factors, particularly the reinforcing factor of social support in order to promote optimal child survival practice among caregivers in AMAC IDP camps. Collaboration with social work professionals would be an added benefit to enhance social support.
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Affiliation(s)
- Saratu Omagbemi Ajike
- Department of Public Health, School of Public and Allied Health, Babcock University, Ilishan-Remo, Ogun State, Nigeria
| | - Busola Loveall Oloyede
- Department of Public Health, School of Public and Allied Health, Babcock University, Ilishan-Remo, Ogun State, Nigeria
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Asmamaw DB, Habitu YA, Mekonnen EG, Negash WD. Antenatal care booked rural residence women have home delivery during the era of COVID-19 pandemic in Gidan District, Ethiopia. PLoS One 2023; 18:e0295220. [PMID: 38051747 DOI: 10.1371/journal.pone.0295220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/18/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND World Health Organization (WHO) recommends that every pregnant woman receive quality care throughout pregnancy, childbirth, and the postnatal period. It is estimated that institutional delivery could reduce 16% to 33% of maternal deaths. Despite the importance of giving birth at a health institution, in Ethiopia, according to the Ethiopian Demographic Health Survey report, nearly half of the ANC-booked mothers gave birth at home. Therefore, this study aimed to determine the prevalence and associated factors of home delivery among antenatal care-booked women in their last pregnancy during the era of COVID-19. METHODS A community-based cross-sectional study was conducted from March 30 to April 29, 2021. A simple random technique was employed to select 770 participants among women booked for antenatal care. Interviewer-administered questionnaires were used to collect the data. A binary logistic regression model was fitted. Adjusted odds ratios with its respective 95% confidence interval were used to declare the associated factors. RESULTS The prevalence of home delivery was 28.8% (95% CI: 25.7, 32.2). Rural residence (AOR = 2.02, 95% CI: 1.23, 3.34), unmarried women (AOR = 11.16, 95% CI: 4.18, 29.79), husband education (AOR = 2.60, 95% CI: 1.72, 3.91), not being involved in the women's development army (AOR = 1.64, 95% CI: 1.01, 2.65), and fear of COVID-19 infection (AOR = 3.86, 95% CI: 2.31, 6.44) were significantly associated factors of home delivery. CONCLUSION Even though the government tried to lower the rate of home delivery by accessing health institutions in remote areas, implementing a women's development army, and introducing maternal waiting home utilization, nearly one in every three pregnant women gave birth at home among ANC booked women in their last pregnancy. Thus, improving the husband's educational status, providing information related to health institution delivery benefits during antenatal care, and strengthening the implementation of the women's development army, particularly among rural and unmarried women, would decrease home childbirth practices.
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Affiliation(s)
- Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Ayanaw Habitu
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eskedar Getie Mekonnen
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Biset G, Goshiye D, Gedamu S, Tsehay M. The effect of conflict on child and adolescent health in Amhara region, Ethiopia: Cross-Sectional Study. BMC Pediatr 2023; 23:463. [PMID: 37710207 PMCID: PMC10500724 DOI: 10.1186/s12887-023-04282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Currently, conflict become common phenomenon in the world affecting the lives of millions of children. Due the continued conflict in Ethiopia millions of children are suffering from extreme levels of violence, lack of basic humanitarian needs, and lack of health services. OBJECTIVE This study was designed to assess the effect of conflict on child and adolescent health in Amhara region, September 2022. METHODS A community-based cross-sectional study was employed among children agedd < 18 years in conflict affected areas of Amhara region. The sample size was determined using a single population proportion formula. Data was collected through face-to-face interviews of children or child legal guardians. Data was cleaned, verified, and entered into EpiData version 3.1 and analysis was done using SPSS version 24 statistical software. RESULT Seven hundred and ninety-eight children agedd less than 18 years were involved with a response rate of 94.33 percent. More than one thirds (276, 34.59%) of children were displaced due to the conflict. Three hundred and thirty one (41.48%) children get diseased with the majority didn't receive treatment. More than two thirds (557, 69.80%) of children had experienced violence of different types. One hundred and thirty four (41.23%) children had acute malnutrition with two third (66.42%) of them had severe acute malnutrition. CONCLUSION Conflict had deadly impacts on the lives of children and adolescents. It causes massive displacement, lack of basic humanitarian needs, extreme level of violence, hunger and malnutrition, and lack of health services. The government and other national and international humanitarian aids should give special attention to children living in war zone of Amhara region. In addition, rehabilitation services and resilience training should be designed and provided to children affected by the conflict.
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Affiliation(s)
- Gebeyaw Biset
- Department of Pediatric and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, PO. Box 1145, Dessie, Ethiopia.
| | - Debrnesh Goshiye
- Department of Pediatric and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, PO. Box 1145, Dessie, Ethiopia
| | - Sisay Gedamu
- Department of Adult Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mekonnen Tsehay
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Neyazi N, Mosadeghrad AM, Tajvar M, Safi N. Trend analysis of noncommunicable diseases and their risk factors in Afghanistan. Chronic Dis Transl Med 2023; 9:210-221. [PMID: 37711869 PMCID: PMC10497825 DOI: 10.1002/cdt3.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/09/2023] Open
Abstract
Background Afghanistan is suffering from 40-year chronic conflicts, displacement, and demolition of its infrastructure. Afghanistan mortality survey 2010 shows nearly 46% of all deaths in the country were attributed to noncommunicable diseases (NCDs). In this study, we aimed to understand the differences in mortality and premature death due to NCDs by sex and the trend for the next 8 years. Methods We applied trend analysis using the secondary data from the Institute for Health Metrics and Evaluation, Global Burden of Diseases 2019. The information on NCD mortality, NCD deaths attributed to its risk factors, NCD percent of total years lived with disability (YLDs) attribution to each risk factor extracted from this database from 2008 to 2019. We investigated the trend from 2008 to 2019 for the mentioned factors and then forecast their trends until 2030. Results Our study shows that Afghanistan has had an increasing death number due to NCDs from 2008 to 2019 (50% for both sexes) and this will reach nearly 54% by 2030. Currently, half of NCDs deaths are premature in Afghanistan. The mortality rate and prevalence of risk factors are higher among women. More than 70% of YLDs will be due to NCDs in Afghanistan till 2030. Five risk factors including high systolic blood pressure (28.3%), high body mass index (23.4%), high blood glucose (20.6%), high low-density lipoprotein cholesterol (16.3%), and smoking (12.3%) will have the highest contribution to NCDs death in 2030, respectively. Conclusions In general, our study indicates that without any specific intervention to address NCDs in Afghanistan, not only the Sustainable Development Goal target for NCDs will not be met, but an increase in almost all risk factors prevalence, as well as NCD mortality, will be seen in Afghanistan.
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Affiliation(s)
- Narges Neyazi
- International Campus, School of Public HealthTehran University of Medical SciencesTehranIran
- Department of Health System DevelopmentWorld Health OrganizationKabulAfghanistan
| | - Ali Mohammad Mosadeghrad
- Department of Health Management, Policy and Economics, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Maryam Tajvar
- Department of Health Management, Policy and Economics, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Najibullah Safi
- Department of Health System DevelopmentWorld Health OrganizationKabulAfghanistan
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Abraha HE, Tequare MH, Teka H, Gebremedhin MB, Desta KG, Ebrahim MM, Yemane A, Gebremariam SM, Gebresilassie KB, Tekle TH, Atsbaha MT, Berhe E, Berhe B, Berhe DF, Gebregziabher M, Wall LL. Impact of a double catastrophe, war and COVID-19, on health service utilization of a tertiary care hospital in Tigray: an interrupted time-series study. Confl Health 2023; 17:37. [PMID: 37580780 PMCID: PMC10426210 DOI: 10.1186/s13031-023-00537-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 08/09/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND In developing nations with fragile healthcare systems, the effect of war is likely to be much worse than it would be in more developed countries. The presence of COVID-19 will also likely exacerbate the war's impact. This study set out to determine the effect of armed conflict and the COVID-19 pandemic on health service utilization at Ayder Comprehensive Specialized Hospital, in the Tigray region of Ethiopia. METHODS An interrupted time-series study design was used to analyze patient visits over forty-eight consecutive months (from July 2017 to June 2021) at inpatient, outpatient, and emergency departments. Data were analyzed using segmented regression analysis with a defined outcome of level and trend changes in the number of patient visits. In addition, negative binomial regression analysis was also used to estimate the impact of both COVID-19 and the war on patient flow. RESULTS There were 59,935 admissions, 876,533 outpatient visits, and 127,872 emergency room visits. The effect of COVID-19 was seen as soon as the Tigray regional government imposed comprehensive restrictions. Immediately after COVID-19 appeared, all the service areas exhibited a significant monthly drop in visits; [-35.6% (95% CI: -48.2%, -23.1%)] for inpatient, [-60.6% (95% CI: -71.6%, -49.5%)] for outpatient, and [-44.1% (95% CI: -59.5%, -28.7%)] for emergency department visits. The impact of the war became apparent after a lag time of one month. Controlling the effects of time and COVID-19, the war led to a significant fall in inpatient visits [-44.3% (95% CI: -67.2%, -21.5%)], outpatients [-52.1% (95% CI: -82.7%, -21.5%)], and emergency-room attendances [-45.0% (95% CI: -74.8%, -15.2%)]. An upward trend in outpatient flow was observed after the war [1,219.4 (95% CI: 326.1, 2,112.8)]. CONCLUSIONS The present study has clearly indicated that the war and COVID-19 have led to a large reduction in admissions, outpatient attendance, and emergency department visits. The evidence from this study suggests that due to this double catastrophe, thousands of patients could not gain access to healthcare, with probable negative consequences. Governments and organizations should implement measures to buttress the healthcare system to maintain pre-war status of service.
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Affiliation(s)
| | | | - Hale Teka
- College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | | | | | - Awol Yemane
- College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | | | | | | | - Ephrem Berhe
- College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Bereket Berhe
- College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | | | - L Lewis Wall
- College of Health Sciences, Mekelle University, Tigray, Ethiopia
- Washington University in St. Louis, St. Louis, MO, USA
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Amberg F, Chansa C, Niangaly H, Sankoh O, De Allegri M. Examining the relationship between armed conflict and coverage of maternal and child health services in 35 countries in sub-Saharan Africa: a geospatial analysis. Lancet Glob Health 2023; 11:e843-e853. [PMID: 37202021 DOI: 10.1016/s2214-109x(23)00152-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Armed conflict is on the rise in sub-Saharan Africa and affects public infrastructures, including health systems, although evidence on population health is sparse. We aimed to establish how these disruptions ultimately affect health service coverage. METHODS We geospatially matched Demographic and Health Survey data with the Uppsala Conflict Data Program Georeferenced Events Dataset, covering 35 countries for the period from 1990 to 2020. We relied on linear probability models with fixed effects to capture the effect of nearby armed conflict (within 50 km of the survey cluster) on four service coverage indicators along the continuum of maternal and child health care. We also investigated effect heterogeneity by varying conflict intensity and duration, and sociodemographic status. FINDINGS The estimated coefficients represent the decrease in the probability (in percentage points) of the child or their mother being covered by the respective health service following deadly conflicts within 50 km. Any nearby armed conflict was associated with reduced coverage for all examined health services, with the exception of early antenatal care: early antenatal care (-0·5 percentage points, 95% CI -1·1 to 0·1), facility-based delivery (-2·0, -2·5 to -1·4), timely childhood vaccination (-2·5, -3·1 to -1·9), and treatment of common childhood illnesses (-2·5, -3·5 to -1·4). For all four health services, the negative effects increased for high-intensity conflicts and were significant throughout. When examining conflict duration, we did not find negative effects on the treatment of common childhood illnesses in prolonged conflicts. The analysis on effect heterogeneity revealed that, except for timely childhood vaccination, the negative effects of armed conflict on health service coverage were more pronounced in urban settings. INTERPRETATION Our findings suggest that health service coverage is significantly affected by contemporaneous conflict, but health systems can adapt to provide routine services, such as child curative services, in situations of prolonged conflict. Our analysis underlines the importance of studying health service coverage during conflict both at the finest possible scales and across different indicators, pointing at the need for differential policy interventions. FUNDING None. TRANSLATIONS For the French and Portuguese translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Felix Amberg
- Heidelberg Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany.
| | - Collins Chansa
- Heidelberg Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany; Health, Nutrition, and Population Global Practice, World Bank Group, Monrovia, Liberia
| | - Hamidou Niangaly
- Department of Medical and Community Studies and Research, National Institute of Public Health, Bamako, Mali
| | - Osman Sankoh
- Heidelberg Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany; Statistics Sierra Leone, Freetown, Sierra Leone; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg, Germany
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Gedef GM, Gashaw A, Bitew DA, Andualem F. Institutional delivery service utilization and associated factors in fragile and conflict-affected situations in Sekota town, Northern Ethiopia, 2022: A community-based cross-sectional study. Heliyon 2023; 9:e16239. [PMID: 37215847 PMCID: PMC10196959 DOI: 10.1016/j.heliyon.2023.e16239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
Background Conflict-affected areas are considered to contribute a substantial proportion of worldwide maternal deaths. However, research on maternal health care in conflict-affected countries is very limited. In the absence of recent data, it is impossible to monitor progress made in mitigating the effect of conflict on maternal survival. As a result, this study targeted to assess institutional delivery services usage and influencing factors in a fragile and conflict-affected situation in Sekota town, Northern Ethiopia. Methods A community-based cross-sectional study was employed among 420 mothers in Sekota town, Northern Ethiopia from July 15th to 30th, 2022. The desired sample size was determined using a single population proportion formula. The data were collected by using interviewer administered structured questionnaire; entered via EpiData version 4.6 and analyzed using SPSS version 25 software. To identify the associated factors, a bivariable and multivariable logistic regression model was applied. The level of significance was declared at a p-value of <0.05. An adjusted odds ratio with a 95% confidence interval was considered to see the strength of the association between dependent and independent variables. Results Of the total respondent, 202 (48.1%), 95% CI: (43.0%, 53.0%) mothers utilized institutional delivery service. The use of institutional delivery services was associated with the maternal educational level of secondary school and above (AOR = 2.06, 95% CI: 1.08-3.93), antenatal care during the most recent pregnancy (AOR = 5.24, 95% CI: 3.01-9.11), being informed on birth preparedness and complication readiness (AOR = 1.93, 95% CI: 1.23-3.02) and displacement of the respondents from their usual place of residence due to conflict (AOR = 0.41, 95% CI: 0.21-0.68). Conclusion Institutional delivery service utilization was very low in the study setting. Healthcare for women in conflict-prone areas requires critical attention and should be given priority during the conflict. More prospective research is needed to fully understand and reduce the impact of conflict on maternal and neonatal health care.
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Affiliation(s)
- Getachew Muluye Gedef
- School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Abeba Gashaw
- Department of Maternal and Child Health, Amdework Primary Hospital, Waghimra Zone, Amhara Region, Ethiopia
| | - Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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11
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Morris CN, Meehan K, Had H, Barasa SO, Zainul H, Hynes M, Amsalu R. Factors that influence compliance for referral from primary care to hospital for maternal and neonatal complications in Bosaso, Somalia: a qualitative study. BMJ Open 2023; 13:e070036. [PMID: 37055216 PMCID: PMC10106055 DOI: 10.1136/bmjopen-2022-070036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES To estimate referral compliance and examine factors that influence decisions to comply with referral for newborn and maternal complications in Bosaso, Somalia. SETTING Bosaso, Somalia, is a large port city that hosts a large proportion of internally displaced persons. The study was conducted at the only four primary health centres offering 24/7 delivery services and the only public referral hospital in Bosaso. PARTICIPANTS All pregnant women who sought care at four primary centres and were referred to the hospital for maternal complications or mothers whose newborns were referred for neonatal complications were approached for enrolment from September to December 2019. In-depth interviews (IDIs) of 54 women and 14 healthcare workers (HCWs) were conducted. OUTCOME MEASURES This study examined timely referral compliance from the primary centre to the hospital. IDIs were analysed for a priori themes investigating the decision-making process and experience of care for maternal and newborn referrals. RESULTS Overall, 94% (n=51/54) of those who were referred, 39 maternal and 12 newborns, complied with the referral and arrived at the hospital within 24 hours. Of the three that did not comply, two delivered on the way, and one cited lack of money as the reason for noncompliance. Four themes emerged: trust in medical authority, cost of transportation and care, quality of care, and communications. The factors that facilitated compliance were the availability of transportation, family support, concern for health, and trust in medical authority. HCWs raised the importance of considering the maternal-newborn dyad throughout the referral process, and the need for official standard operating procedures for referrals including communications between the primary care and the hospital. CONCLUSIONS High compliance for referral from primary to hospital care for maternal and newborn complications was observed in Bosaso, Somalia. Costs associated with transportation and care at the hospital need attention to motivate compliance.
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Affiliation(s)
- Catherine N Morris
- Global Health, Save the Children Federation Inc, Washington, District of Columbia, USA
| | - Kate Meehan
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hussein Had
- Department of Health and Nutrition, Save the Children Somalia, Bosaso, Somalia
| | | | - Hasna Zainul
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle Hynes
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ribka Amsalu
- Global Health, Save the Children Federation Inc, Washington, District of Columbia, USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
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12
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Kaseje N, Hassan K, Muriithi J, Burton J, Weswa B, Ojwando K, Chirchir C, Kinara S, Cunningham D, Okelo S. Partnering to deliver sustainable children's surgical care in Kakuma refugee camp. Lancet 2023; 401:328-331. [PMID: 35724669 DOI: 10.1016/s0140-6736(22)01105-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Neema Kaseje
- Surgical Systems Research Group, Kisumu, Kenya; London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Khalid Hassan
- Turkana Ministry of Health, Lodwar County Referral Hospital, Lodwar, Turkana, Kenya
| | | | | | - Benjamin Weswa
- International Rescue Committee Kakuma, Kakuma, Turkana, Kenya
| | - Kefa Ojwando
- International Rescue Committee Kakuma, Kakuma, Turkana, Kenya
| | - Collins Chirchir
- Turkana Ministry of Health, Lodwar County Referral Hospital, Lodwar, Turkana, Kenya
| | | | | | - Stephen Okelo
- Kenya Society of Anaesthesiologists, KMA Centre, Nairobi, Kenya
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13
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The mental health consequences on children of the war in Ukraine: A commentary. Psychiatry Res 2022; 317:114798. [PMID: 36057188 DOI: 10.1016/j.psychres.2022.114798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/20/2022]
Abstract
The news from Ukraine is currently full of heart-wrenching stories accompanied by graphic images of civilian casualties and massacres that are telecast world-wide on a daily basis. It is hard to fathom the magnitude of the devastation and disruption to regular lives and everyday routines that war brings with it, the witnessing of countless deaths, the associated trauma of living in perpetual fear, and the daily experience of many families and orphans who are crowded into basement bomb shelters now for months on end. These issues make us contemplate the mental health consequences, among other lasting effects, of this costly war in Ukraine, and wars in other countries not so widely featured in Western news. Despite people of all ages being affected by war, children are especially vulnerable. This commentary outlines some of the epidemiology of the consequences of war, the mental health sequelae specifically, and the complexity of providing culturally and contextually relevant interventions that meet the needs of children.
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14
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Neyazi N, Safi N, Afzali A, Kabir M. Gender barriers are worsening women's access to health care in Afghanistan. Lancet 2022; 400:731-732. [PMID: 36058220 DOI: 10.1016/s0140-6736(22)01522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Narges Neyazi
- Health System Development, World Health Organization, Kabul 1001, Afghanistan.
| | - Najibullah Safi
- Health System Development, World Health Organization, Kabul 1001, Afghanistan
| | - Anita Afzali
- Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Misha Kabir
- University College London Hospital, London, UK
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15
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Callister LC. Supporting Refugee Women and Children During Armed Conflict. MCN Am J Matern Child Nurs 2022; 47:297. [PMID: 35960223 DOI: 10.1097/nmc.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Lynn Clark Callister
- Dr. Lynn Clark Callister is a Professor Emerita, College of Nursing, Brigham Young University, Provo, UT. Dr. Callister can be reached via email at
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16
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Basha S, Socarras A, Akhter MW, Hamze M, Albaik A, Hussein I, Tarakji A, Hamadeh M, Loutfi R, Kewara M, Alahdab F, Abbara A. Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria. BMJ Glob Health 2022; 7:bmjgh-2021-008001. [PMID: 36041781 PMCID: PMC9438041 DOI: 10.1136/bmjgh-2021-008001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/12/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Syria’s protracted conflict has devastated the health system reversing progress made on maternal health preconflict. Our aim is to understand the state of maternal health in Syria focused on underage pregnancy and caesarean sections using a scoping review and quantitative analysis; the latter draws on data from the Syrian American Medical Society’s (SAMS) maternal health facilities in northwest Syria. Methods We performed a scoping review of academic and grey literature on the state of maternal health across Syria since the onset of conflict (taken as March 2011). Identified articles were screened using pre-established criteria and themes identified. We also performed a retrospective quantitative analysis of maternal health data from SAMS’ facilities in a microcontext in north-west Syria between March 2017 and July 2020, analysing the trends in the proportion of births by caesarean section and age at pregnancy. Results Scoping review: of 2824 articles, 21 remained after screening. Main themes related to maternal mortality rates, caesarean sections, maternal age and perinatal care. 12 studies reported caesarean section rates; these varied from 16% to 64% of all births: northern Syria (19%–45%,) Damascus (16%–54%,) Lattakia (64%) and Tartous (59%.) Quantitative analysis: Of 77 746 births across 17 facilities, trend data for caesarean sections showed a decrease from 35% in March 2017 to 23% in July 2020 across SAMS facilities. Girls under 18 years accounted for 10% of births and had a lower proportion of caesarean section births. There was notable geographical and interfacility variation in the findings. Conclusion The quality of available literature was poor with country-level generalisations. Research which explores microcontexts in Syria is important given the different effects of conflict across the country and the fragmented health system. Our quantitative analysis provides some evidence around the changes to caesarean section rates in northwest Syria. Despite limitations, this study adds to sparse literature on this important topic.
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Affiliation(s)
- Sara Basha
- School of Medicine, University of Aberdeen, Aberdeen, UK
| | - Alex Socarras
- Syrian American Medical Society, Washington, District of Columbia, USA
| | | | | | - Ahmad Albaik
- Syrian American Medical Society, Gaziantep, Turkey
| | - Imad Hussein
- Syrian American Medical Society, Gaziantep, Turkey
| | - Ahmad Tarakji
- Syrian American Medical Society, Washington, District of Columbia, USA
| | - Mufaddal Hamadeh
- Syrian American Medical Society, Washington, District of Columbia, USA
| | - Randa Loutfi
- Syrian American Medical Society, Washington, District of Columbia, USA
| | - Mazen Kewara
- Syrian American Medical Society, Gaziantep, Turkey
| | - Fares Alahdab
- Syrian American Medical Society, Washington, District of Columbia, USA
| | - Aula Abbara
- Syrian American Medical Society, Washington, District of Columbia, USA .,Department of Infection, Imperial College, London, UK
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17
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Matta-Chuquisapon J, Gianella C, Carrasco-Escobar G. Missed opportunities for vaccination in Peru 2010-2020: A study of socioeconomic inequalities. LANCET REGIONAL HEALTH. AMERICAS 2022; 14:100321. [PMID: 36777386 PMCID: PMC9904149 DOI: 10.1016/j.lana.2022.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Missed Opportunities for Vaccination (MOV) represent a major risk in the re-emergence of immunopreventable diseases. However, in the region, there are few published studies on MOVs using national databases such as demographic and health surveys (DHS). This study aims to describe the frequency and trends of MOVs for the first dose of vaccines against the leading causes of infant morbidity and mortality, their complete vaccination coverage, and trends in socioeconomic inequalities at the national and departmental levels for an 11-years period. Methods Using DHS data from an 11-year period (2010-2020), we calculated frequencies and trends in MOVs of vaccines for the leading causes of child morbidity and mortality, estimated inequalities in MOVs using the Slope Inequality Index (SII) and conducted a spatial autocorrelation test to identify clusters of higher or lower inequality in MOVs at the national level. Findings We found that, at the national level, greater inequality was concentrated in the wealthiest categories of each socioeconomic variable. We identified that departments with higher poverty rates concentrated higher levels of inequality in the MOVs in the lowest strata of the socioeconomic variables. In addition, we found that some departments with similar geographic and socioeconomic characteristics had spatially correlated levels of inequality on MOVs. Interpretation These findings can help to identify the heterogeneity that exists in the distribution of MOVs among departments and socioeconomic strata, which would help to prioritize specific areas and subpopulations for national immunization strategies. Funding No additional funding source was required for this study.
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Affiliation(s)
- Jose Matta-Chuquisapon
- Health Innovation Laboratory, Institute of Tropical Medicine “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru,Corresponding author.
| | | | - Gabriel Carrasco-Escobar
- Health Innovation Laboratory, Institute of Tropical Medicine “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru,School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru,Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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18
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Neves RG, Saes MDO, Duro SMS, Flores TR, Tomasi E. Inequalities in care for the people with diabetes in Brazil: A nationwide study, 2019. PLoS One 2022; 17:e0270027. [PMID: 35767515 PMCID: PMC9242508 DOI: 10.1371/journal.pone.0270027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
The purpose of this paper is to evaluate inequalities in care for people with diabetes in Brazil. This cross-sectional population-based study was carried out in 2019 and evaluated care provided by receiving advice, requesting laboratory tests, and performing examinations. We used the slope index of inequality and concentration index to assess inequalities according to educational level and Poisson regression to estimate prevalence ratios for each outcome in the education category. We assessed a total of 6317 people with diabetes, 41.8% had their eyes checked, and 36.1% had their feet examined in the previous year. Prevalence for both examinations was 2.45 times higher in those from the highest level of education compared to those from the lowest level. The largest absolute differences (in percentage points) between the lowest and highest education levels in care indicators were the following: request for glycated hemoglobin test (39.0), glucose curve test (31.4), and eyes checked in the previous year (29.7). There were notable inequalities in the prevalence ratios of care provided to people with diabetes in Brazil. Requests for glycated hemoglobin tests, glucose curve tests, eye and feet examinations should be emphasized, especially for people from lower educational levels.
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Affiliation(s)
| | | | | | - Thaynã Ramos Flores
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Elaine Tomasi
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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19
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Mamkhezri J, Razzaghi S, Khezri M, Heshmati A. Regional Effects of Maternal Mortality Determinants in Africa and the Middle East: How About Political Risks of Conflicts? Front Public Health 2022; 10:865903. [PMID: 35651864 PMCID: PMC9149158 DOI: 10.3389/fpubh.2022.865903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background As per the United Nations Women data, the maternal mortality rate in war-affected countries is critical and more than 800 million people live in war-affected countries (ICRC). External and internal conflicts such as foreign pressure, war and cross-border, civil disorder, terrorism, and civil war, are characteristics of Middle Eastern and African countries. Therefore considering the rapid increment of political risks and internal and external conflicts in Africa and the Middle East during the last decade, and considering warfare as a key contributor to maternal mortality; This paper seeks to evaluate the factors that have caused significant rates of maternal mortality in Middle Eastern and African countries by emphasizing the contributions of a number of political risk aspects as Civil Disorder Index, Terrorism Index, Civil War Index, Foreign Pressures Index, Cross-Border Conflict Index, War Index along with other socio-economic factors. Method Data were collected from forty-six countries during 2011–2016 to explore the regional contributions of political risk aspects to the maternal mortality rate through spatial approaches. Results It was found that GDP per capita, energy intensity, and urbanization strongly impacted maternal mortality. Also, it was observed that natural resource rents and economic growth significantly influenced the reduction of mortality by expanding healthcare services. The urban expansion was found to have elevated maternal mortality. A majority of external and internal conflicts reduced the orientation of production toward healthcare services and thus raised maternal mortality. On the other hand, war and cross-border were found to pose opposite impacts. Conclusion The findings revealed that political risks arising from terrorism, foreign pressure, and war in the adjacent countries would elevate the rate of mortality in the original country. This implies the spillover impacts of regional conflicts on maternal mortality elevation at the regional scale. JEL Classification Codes: C23; I10; I18; N37:
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Affiliation(s)
- Jamal Mamkhezri
- Department of Economics, Applied Statistics and International Business, New Mexico State University, Las Cruces, NM, United States
| | - Somayeh Razzaghi
- Assistant Professor of Economics, Faculty of Economics and Social Sciences, Bu-Ali Sina University, Hamadan, Iran
| | - Mohsen Khezri
- Department of Economics and Finance, School of Management and Economics, University of Kurdistan Hewlêr (UKH), Erbil, Iraq
| | - Almas Heshmati
- Professor of Economics, Jönköping International Business School, Jönköping University, Jönköping, Sweden
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20
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Bwirire D, Crutzen R, Ntabe Namegabe E, Letschert R, de Vries N. Health inequalities in post-conflict settings: A systematic review. PLoS One 2022; 17:e0265038. [PMID: 35286351 PMCID: PMC8920275 DOI: 10.1371/journal.pone.0265038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Conflict can be a primary driver of health inequalities, but its impact on the distribution of social determinants of health is not very well documented. Also, there is limited evidence on the most suitable approaches aiming at addressing health inequalities in post-conflict settings. Thus, we undertook a systematic review of the literature concerning the current knowledge and knowledge gaps about structural determinants of health inequalities and assessed the effects of approaches aimed at addressing health inequalities in post-conflict settings. We performed a systematic search in bibliographic databases such as Web of Science, PubMed, and PsycINFO for relevant publications, as well as institutional websites that are relevant to this topic. The search was initiated in March 2018 and ultimately updated in December 2020. No time or geographical restrictions were applied. The quality of each study included in this review was independently assessed using criteria developed by CASP to assess all study types. Sixty-two articles were deemed eligible for analysis. The key findings were captured by the most vulnerable population groups, including the civilian population, women, children, internally displaced persons (IDPs), and people with symptoms of mental illness. A considerable range of approaches has been used to address health inequalities in post-conflict settings. These approaches include those used to address structural determinants of health inequalities which are accountable for the association between poverty, education, and health inequalities, the association between human rights and health inequalities, and the association between health inequalities and healthcare utilization patterns. However, these approaches may not be the most applicable in this environment. Given the multifactorial characteristics of health inequalities, it is important to work with the beneficiaries in developing a multi-sector approach and a strategy targeting long-term impacts by decision-makers at various levels. When addressing health inequalities in post-conflict settings, it may be best to combine approaches at different stages of the recovery process.
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Affiliation(s)
- Dieudonne Bwirire
- Faculty of Health, Medicine and Life Science, Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rik Crutzen
- Faculty of Health, Medicine and Life Science, Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Edmond Ntabe Namegabe
- Faculté de Santé et Développement Communautaires, Université Libre des Pays des Grands Lacs (ULPGL), Goma, Democratic Republic of the Congo
| | | | - Nanne de Vries
- Faculty of Health, Medicine and Life Science, Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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21
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Liu L, Villavicencio F, Yeung D, Perin J, Lopez G, Strong KL, Black RE. National, regional, and global causes of mortality in 5–19-year-olds from 2000 to 2019: a systematic analysis. Lancet Glob Health 2022; 10:e337-e347. [PMID: 35180417 PMCID: PMC8864304 DOI: 10.1016/s2214-109x(21)00566-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/04/2021] [Accepted: 11/29/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Li Liu
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Francisco Villavicencio
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Centre for Demographic Studies, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diana Yeung
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gerard Lopez
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Kathleen L Strong
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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22
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Eliakimu ES, Mans L. Addressing Inequalities Toward Inclusive Governance for Achieving One Health: A Rapid Review. Front Public Health 2022; 9:755285. [PMID: 35127612 PMCID: PMC8811029 DOI: 10.3389/fpubh.2021.755285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/27/2021] [Indexed: 12/03/2022] Open
Abstract
Sustainable development goals (SDGs) adopted in 2015 are geared toward sustainable development through various pathways, one being reducing inequality as covered in SDG 10. Inequalities are a threat to health and wellbeing of populations and a planet Earth in which we live. This rapid review aims to identify key issues that are likely to exacerbate inequalities around the six SDGs directly related to One Health, which are SDG 3, 6, 11, 13, 14 and 15, and suggest some actions that may help to address them using inclusive governance taking into account the coronavirus disease of 2019 (COVID-19) pandemic. Informed by the literature on SDGs and using the “inclusive development concept” by Gupta and Vegelin, literature search was done in Google Scholar, PubMed Central, as well as, searching of references in the relevant articles identified using search terms from the six SDGs that are directly related to One Health. In the context of the SDGs, in order to achieve One Health through inclusive governance, and tackle inequalities, the following needs to be considered and addressed: increasing number of armed conflicts; ongoing COVID-19 pandemic; ensuring availability of water and sanitation facilities; improving city and urban areas planning to cope with climate change; improving governance arrangements for addressing climate change factoring gender and human rights; multisectoral planning for conservation of oceans, seas, and marine resources; balancing trade regulation of wildlife trade with conservation efforts; need for a research collaborative involving experts from environmental sciences, wildlife, agriculture and human health to study and develop scientific evidence on contribution of changes in land use practices to occurrence of zoonotic diseases; and need of a legislation for promoting animal welfare to protect public health. Also, inclusion of people with disabilities in the use of digital technologies is critical.
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Affiliation(s)
- Eliudi S. Eliakimu
- Health Quality Assurance Unit, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
- *Correspondence: Eliudi S. Eliakimu ;
| | - Linda Mans
- An Independent Consultant and Researcher in Support of Healthy People and a Healthy Planet, Manskracht, Nijmegen, Netherlands
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23
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Martinez Garcia D, Amsalu R, Harkensee C, Janet S, Kadir A, Kampalath VN, Nejat S, Wise PH. Humanitarian paediatrics: A statement of purpose. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001431. [PMID: 36962911 PMCID: PMC10021314 DOI: 10.1371/journal.pgph.0001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Daniel Martinez Garcia
- Geneva University Paediatric Hospital, Geneva, Switzerland
- Médecins Sans Frontières, Toronto, Canada
| | - Ribka Amsalu
- California Preterm Birth Initiative, Department of Obstetrics, Gynaecology, & Reproductive Sciences, University of California San Francisco, San Francisco, San Francisco, California, United States of America
| | | | | | | | - Vinay N Kampalath
- Division of Emergency Medicine, Department of Paediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | | | - Paul H Wise
- Stanford University School of Medicine, Stanford, California, United States of America
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24
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Kampalath V, MacLean S, AlAbdulhadi A, Congdon M. The delivery of essential newborn care in conflict settings: A systematic review. Front Pediatr 2022; 10:937751. [PMID: 36389389 PMCID: PMC9663655 DOI: 10.3389/fped.2022.937751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Although progress has been made over the past 30 years to decrease neonatal mortality rates, reductions have been uneven. Globally, the highest neonatal mortality rates are concentrated in countries chronically affected by conflict. Essential newborn care (ENC), which comprises critical therapeutic interventions for every newborn, such as thermal care, initiation of breathing, feeding support, and infection prevention, is an important strategy to decrease neonatal mortality in humanitarian settings. We sought to understand the barriers to and facilitators of ENC delivery in conflict settings. METHODS We systematically searched Ovid/MEDLINE, Embase, CINAHL, and Cochrane databases using terms related to conflict, newborns, and health care delivery. We also reviewed grey literature from the Healthy Newborn Network and several international non-governmental organization databases. We included original research on conflict-affected populations that primarily focused on ENC delivery. Study characteristics were extracted and descriptively analyzed, and quality assessments were performed. RESULTS A total of 1,533 abstracts were screened, and ten publications met the criteria for final full-text review. Several barriers emerged from the reviewed studies and were subdivided by barrier level: patient, staff, facility, and humanitarian setting. Patients faced obstacles related to transportation, cost, and access, and mothers had poor knowledge of newborn danger signs. There were difficulties related to training and retaining staff. Facilities lacked supplies, protocols, and data collection strategies. CONCLUSIONS Strategies for improved ENC implementation include maternal and provider education and increasing facility readiness through upgrades in infrastructure, guidelines, and health information systems. Community-based approaches may also play a vital role in strengthening ENC.
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Affiliation(s)
- Vinay Kampalath
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Center for Global Health, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sarah MacLean
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Abrar AlAbdulhadi
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Morgan Congdon
- Center for Global Health, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Section of Hospital Medicine, Division of General Pediatrics, Department of Pediatrics, Global Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Pediatric Infectious Diseases Encountered During Wartime-Part 1: Experiences and Lessons Learned From Armed Conflict in the Modern Era. Curr Infect Dis Rep 2021; 23:27. [PMID: 34903952 PMCID: PMC8656442 DOI: 10.1007/s11908-021-00770-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 11/18/2022]
Abstract
Purpose of Review Armed conflicts occur globally, with some regions experiencing heightened instability for many years. A better understanding of the infectious disease impact on children in armed conflict will allow aid organizations to anticipate and mitigate the most serious problems. Recent Findings Armed conflicts are estimated to have caused approximately 30 million civilian deaths during the past 27 years, with two-thirds occurring in women and children. Children are extremely vulnerable to the mass population displacements, experiencing a combined loss of safety, nutrition, shelter, hygiene, and health care. Under these circumstances, the emergence and prevalence of multiple infectious diseases can result in heightened morbidity and mortality long after active conflict ceases. Summary Factors leading to increased infectious diseases in populations in crisis due to armed conflict and lessons learned from recent outbreaks are discussed in detail. Acute respiratory infections, diphtheria, measles, varicella, and cholera are a few of the more common infectious diseases that take advantage of populations displaced or disrupted by conflict. Key issues include the ability of countries or non-governmental organizations (NGOs) to keep up with basic childhood immunizations, and how rapidly disease outbreaks are recognized and addressed with disease-specific interventions.
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Ramadan M, Tappis H, Uribe MV, Brieger W. Access to primary healthcare Services in Conflict-Affected Fragile States: a subnational descriptive analysis of educational and wealth disparities in Cameroon, Democratic Republic of Congo, Mali, and Nigeria. Int J Equity Health 2021; 20:253. [PMID: 34895244 PMCID: PMC8665620 DOI: 10.1186/s12939-021-01595-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/17/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Measuring and improving equitable access to care is a necessity to achieve universal health coverage. Pre-pandemic estimates showed that most conflict-affected and fragile situations were off-track to meet the Sustainable Development Goals on health and equity by 2030. Yet, there is a paucity of studies examining health inequalities in these settings. This study addresses the literature gap by applying a conflict intensity lens to the analysis of disparities in access to essential Primary Health Care (PHC) services in four conflict-affected fragile states: Cameroon, Democratic Republic of Congo, Mali and Nigeria. METHODS For each studied country, disparities in geographic and financial access to care were compared across education and wealth strata in areas with differing levels of conflict intensity. The Demographic Health Survey (DHS) and the Uppsala Conflict Data Program were the main sources of information on access to PHC and conflict events, respectively. To define conflict intensity, household clusters were linked to conflict events within a 50-km distance. A cut-off of more than two conflict-related deaths per 100,000 population was used to differentiate medium or high intensity conflict from no or low intensity conflict. We utilized three measures to assess inequalities: an absolute difference, a concentration index, and a multivariate logistic regression coefficient. Each disparity measure was compared based on the intensity of conflict the year the DHS data was collected. RESULTS We found that PHC access varied across subnational regions in the four countries studied; with more prevalent financial than geographic barriers to care. The magnitude of both educational and wealth disparities in access to care was higher with geographic proximity to medium or high intensity conflict. A higher magnitude of wealth rather than educational disparities was also likely to be observed in the four studied contexts. Meanwhile, only Nigeria showed statistically significant interaction between conflict intensity and educational disparities in access to care. CONCLUSION Both educational and wealth disparities in access to PHC services can be exacerbated by geographic proximity to organized violence. This paper provides additional evidence that, despite limitations, household surveys can contribute to healthcare assessment in conflict-affected and fragile settings.
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Affiliation(s)
- Marwa Ramadan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Hannah Tappis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Technical Leadership and Innovations Office, Jhpiego, Baltimore, MD, USA
| | - Manuela Villar Uribe
- Health Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
| | - William Brieger
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Chukwuma A, Wong KLM, Ekhator-Mobayode UE. Disrupted Service Delivery? The Impact of Conflict on Antenatal Care Quality in Kenya. Front Glob Womens Health 2021; 2:599731. [PMID: 34816176 PMCID: PMC8594042 DOI: 10.3389/fgwh.2021.599731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: African countries facing conflict have higher levels of maternal mortality. Understanding the gaps in the utilization of high-quality maternal health care is essential to improving maternal survival in these states. Few studies have estimated the impact of conflict on the quality of health care. In this study, we estimated the impact of conflict on the quality of health care in Kenya, a country with multiple overlapping conflicts and significant disparities in maternal survival. Materials and Methods: We drew on data on the observed quality of 553 antenatal care (ANC) visits between January and April 2010. Process quality was measured as the percentage of elements of client–provider interactions performed in these visits. For structural quality, we measured the percentage of required components of equipment and infrastructure and the management and supervision in the facility on the day of the visit. We spatially linked the analytical sample to conflict events from January to April 2010. We modeled the quality of ANC as a function of exposure to conflict using spatial difference-in-difference models. Results: ANC visits that occurred in facilities within 10,000 m of any conflict event in a high-conflict month received 18–21 percentage points fewer components of process quality on average and had a mean management and supervision score that was 12.8–13.5 percentage points higher. There was no significant difference in the mean equipment and infrastructure score at the 5% level. The positive impact of conflict exposure on the quality of management and supervision was driven by rural facilities. The quality of management and supervision and equipment and infrastructure did not modify the impact of conflict on process quality. Discussion: Our study demonstrates the importance of designing maternal health policy based on the context-specific evidence on the mechanisms through which conflict affects health care. In Kenya, deterioration of equipment and infrastructure does not appear to be the main mechanism through which conflict has affected ANC quality. Further research should focus on better understanding the determinants of the gaps in process quality in conflict-affected settings, including provider motivation, competence, and incentives.
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Affiliation(s)
| | - Kerry L M Wong
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Maruf F, Tappis H, Stekelenburg J, van den Akker T. Quality of Maternal Death Documentation in Afghanistan: A Retrospective Health Facility Record Review. Front Glob Womens Health 2021; 2:610578. [PMID: 34816182 PMCID: PMC8593965 DOI: 10.3389/fgwh.2021.610578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: To assess the quality of health facility documentation related to maternal deaths at health facilities in Afghanistan. Methods: Analysis of a subset of findings from the 2016 National Maternal and Newborn Health Quality of Care Assessment in Afghanistan. At each facility, maternity registers were reviewed to obtain data related to maternity caseload, and number and causes of maternal deaths in the year preceding the survey. Detailed chart reviews were conducted for up to three maternal deaths per facility. Analyses included completeness of charts, quality of documentation, and cause of death using WHO application of International Statistical Classification of Disease to deaths during pregnancy, childbirth and the puerperium. Key findings: Only 129/226 (57%) of facilities had mortality registers available for review on the day of assessment and 41/226 (18%) had charts documenting maternal deaths during the previous year. We reviewed 68 maternal death cases from the 41 facilities. Cause of death was not recorded in nearly half of maternal death cases reviewed. Information regarding mode of birth was missing in over half of the charts, and one third did not capture gestational age at time of death. Hypertensive disorders of pregnancy and obstetric hemorrhage were the most common direct causes of death, followed by maternal sepsis and unanticipated complications of clinical management including anesthesia-related complications. Documented indirect causes of maternal deaths were anemia, cardiac arrest, kidney and hepatic failure. Charts revealed at least eight maternal deaths from indirect causes that were not captured in register books, indicating omission or misclassification of registered deaths. Conclusion: Considerable gaps in quality of recordkeeping exist in Afghanistan, including underreporting, misclassification and incompleteness. This hampers efforts to improve quality of maternal and newborn health data and priority setting.
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Affiliation(s)
- Farzana Maruf
- Global Financing Facility, World Bank Group, Kabul, Afghanistan.,Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Jelle Stekelenburg
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen/University of Groningen, Groningen, Netherlands.,Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, Netherlands
| | - Thomas van den Akker
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
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Kam RL, Cullinane M, Amir LH. Research Challenges and Considerations in Investigating Rare Exposures Using Breast Hypoplasia as an Example. J Hum Lact 2021; 37:633-638. [PMID: 34382473 DOI: 10.1177/08903344211037620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Renee L Kam
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Breastfeeding Service, Royal Women's Hospital, Parkville, Victoria, Australia
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30
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Meagher K, Attal B, Patel P. Exploring the role of gender and women in the political economy of health in armed conflict: a narrative review. Global Health 2021; 17:88. [PMID: 34348740 PMCID: PMC8334332 DOI: 10.1186/s12992-021-00738-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background The ripple effects of protracted armed conflicts include: significant gender-specific barriers to accessing essential services such as health, education, water and sanitation and broader macroeconomic challenges such as increased poverty rates, higher debt burdens, and deteriorating employment prospects. These factors influence the wider social and political determinants of health for women and a gendered analysis of the political economy of health in conflict may support strengthening health systems during conflict. This will in turn lead to equality and equity across not only health, but broader sectors and systems, that contribute to sustainable peace building. Methods The methodology employed is a multidisciplinary narrative review of the published and grey literature on women and gender in the political economy of health in conflict. Results The existing literature that contributes to the emerging area on the political economy of health in conflict has overlooked gender and specifically the role of women as a critical component. Gender analysis is incorporated into existing post-conflict health systems research, but this does not extend to countries actively affected by armed conflict and humanitarian crises. The analysis also tends to ignore the socially constructed patriarchal systems, power relations and gender norms that often lead to vastly different health system needs, experiences and health outcomes. Conclusions Detailed case studies on the gendered political economy of health in countries impacted by complex protracted conflict will support efforts to improve health equity and understanding of gender relations that support health systems strengthening.
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Affiliation(s)
- Kristen Meagher
- Research for Health Systems Strengthening in northern Syria, Conflict and Health Research Group (CHRG), Department of War Studies, King's College London, London, UK.
| | - Bothaina Attal
- Faculty of Medicine and Health Sciences, Sana'a University, Yemen and Centre for Business Research, University of Cambridge, Cambridge, UK
| | - Preeti Patel
- Research for Health Systems Strengthening in northern Syria, Conflict and Health Research Group (CHRG), Department of War Studies, King's College London, London, UK
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Gibson A, Noguchi L, Kinney MV, Blencowe H, Freedman L, Mofokeng T, Chopra M, Dube Q, Ntirushwa D, Nguku A, Banerjee A, Rajbhandari S, Galadanci H, Baye ML, Zyaee P, Tadesse L, Eltayeb D, Gogoi A, Arifeen SE, Sow S, Kuma-Aboagye P. Galvanizing Collective Action to Accelerate Reductions in Maternal and Newborn Mortality and Prevention of Stillbirths. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:268-273. [PMID: 33875488 PMCID: PMC8324194 DOI: 10.9745/ghsp-d-20-00575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
With less than 10 years remaining to achieve the sustainable development goals, there is an urgent need for collective action to accelerate progress for maternal and newborn health and prevention of stillbirths. We outline a new global initiative, AlignMNH, designed to create opportunities to better align efforts and drive improvements.
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Affiliation(s)
- Anita Gibson
- AlignMNH Secretariat, Jhpiego, Baltimore, MD, USA.
| | - Lisa Noguchi
- AlignMNH Secretariat, Jhpiego, Baltimore, MD, USA
| | - Mary V Kinney
- School of Public Health, University of the Western Cape, South Africa
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive & Child Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lynn Freedman
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Tlaleng Mofokeng
- United Nations Human Rights Council on the Right to Health, Commission for Gender Equality, South Africa
| | - Mickey Chopra
- Health, Nutrition and Population Global Practice, World Bank, Washington, DC, USA
| | - Queen Dube
- College of Medicine, University of Malawi, Zomba, Malawi
| | - David Ntirushwa
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | | | | | | | - Hadiza Galadanci
- African Center of Excellence in Population Health and Policy, Nigeria
| | | | - Pashtoon Zyaee
- Advisory Board, Afghan Midwives Association, Kabul, Afghanistan
| | | | | | | | | | - Samba Sow
- Center for Vaccine Development, Bamako, Mali
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Bendavid E, Boerma T, Akseer N, Langer A, Malembaka EB, Okiro EA, Wise PH, Heft-Neal S, Black RE, Bhutta ZA. The effects of armed conflict on the health of women and children. Lancet 2021; 397:522-532. [PMID: 33503456 PMCID: PMC7612212 DOI: 10.1016/s0140-6736(21)00131-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 01/16/2023]
Abstract
Women and children bear substantial morbidity and mortality as a result of armed conflicts. This Series paper focuses on the direct (due to violence) and indirect health effects of armed conflict on women and children (including adolescents) worldwide. We estimate that nearly 36 million children and 16 million women were displaced in 2017, on the basis of international databases of refugees and internally displaced populations. From geospatial analyses we estimate that the number of non-displaced women and children living dangerously close to armed conflict (within 50 km) increased from 185 million women and 250 million children in 2000, to 265 million women and 368 million children in 2017. Women's and children's mortality risk from non-violent causes increases substantially in response to nearby conflict, with more intense and more chronic conflicts leading to greater mortality increases. More than 10 million deaths in children younger than 5 years can be attributed to conflict between 1995 and 2015 globally. Women of reproductive ages living near high intensity conflicts have three times higher mortality than do women in peaceful settings. Current research provides fragmentary evidence about how armed conflict indirectly affects the survival chances of women and children through malnutrition, physical injuries, infectious diseases, poor mental health, and poor sexual and reproductive health, but major systematic evidence is sparse, hampering the design and implementation of essential interventions for mitigating the harms of armed conflicts.
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Affiliation(s)
- Eran Bendavid
- Center for Population Health Sciences, Division of Primary Care and Population Health, Department of Medicine, Stanford University, CA, USA.
| | - Ties Boerma
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children (SickKids), Toronto, ON, Canada; The Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ana Langer
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Espoir Bwenge Malembaka
- Ecole Régionale de Santé Publique, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, DR Congo
| | - Emelda A Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Paul H Wise
- Department of Pediatrics, Stanford University, CA, USA
| | - Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, CA, USA
| | - Robert E Black
- The Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children (SickKids), Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
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Amsalu R, Schulte-Hillen C, Garcia DM, Lafferty N, Morris CN, Gee S, Akseer N, Scudder E, Sami S, Barasa SO, Had H, Maalim MF, Moluh S, Berkelhamer S. Lessons Learned From Helping Babies Survive in Humanitarian Settings. Pediatrics 2020; 146:S208-S217. [PMID: 33004642 DOI: 10.1542/peds.2020-016915l] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
Humanitarian crises, driven by disasters, conflict, and disease epidemics, have profound effects on society, including on people's health and well-being. Occurrences of conflict by state and nonstate actors have increased in the last 2 decades: by the end of 2018, an estimated 41.3 million internally displaced persons and 20.4 million refugees were reported worldwide, representing a 70% increase from 2010. Although public health response for people affected by humanitarian crisis has improved in the last 2 decades, health actors have made insufficient progress in the use of evidence-based interventions to reduce neonatal mortality. Indeed, on average, conflict-affected countries report higher neonatal mortality rates and lower coverage of key maternal and newborn health interventions compared with non-conflict-affected countries. As of 2018, 55.6% of countries with the highest neonatal mortality rate (≥30 per 1000 live births) were affected by conflict and displacement. Systematic use of new evidence-based interventions requires the availability of a skilled health workforce and resources as well as commitment of health actors to implement interventions at scale. A review of the implementation of the Helping Babies Survive training program in 3 refugee responses and protracted conflict settings identify that this training is feasible, acceptable, and effective in improving health worker knowledge and competency and in changing newborn care practices at the primary care and hospital level. Ultimately, to improve neonatal survival, in addition to a trained health workforce, reliable supply and health information system, community engagement, financial support, and leadership with effective coordination, policy, and guidance are required.
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Affiliation(s)
- Ribka Amsalu
- Department of Global Health, Save the Children, Washington, District of Columbia; .,University of California San Francisco, San Francisco, California
| | - Catrin Schulte-Hillen
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | | | - Nadia Lafferty
- Medical Department, Médecins Sans Frontières, Barcelona, Spain
| | - Catherine N Morris
- Department of Global Health, Save the Children, Washington, District of Columbia
| | - Stephanie Gee
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Elaine Scudder
- Department of Global Health, Save the Children, Washington, District of Columbia
| | - Samira Sami
- Department of International Health and Center for Humanitarian Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sammy O Barasa
- Department of Nursing, Kenya Medical Training College, Machakos, Kenya
| | - Hussein Had
- Save the Children, Garowe, Puntland, Somalia
| | | | - Seidou Moluh
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Sara Berkelhamer
- Department of Pediatrics, University of Washington, Seattle, Washington
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Wehrmeister FC, Fayé CM, da Silva ICM, Amouzou A, Ferreira LZ, Jiwani SS, Melesse DY, Mutua M, Maïga A, Ca T, Sidze E, Taylor C, Strong K, Carvajal-Aguirre L, Porth T, Hosseinpoor AR, Barros AJD, Boerma T. Wealth-related inequalities in the coverage of reproductive, maternal, newborn and child health interventions in 36 countries in the African Region. Bull World Health Organ 2020; 98:394-405. [PMID: 32514213 PMCID: PMC7265922 DOI: 10.2471/blt.19.249078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To investigate whether sub-Saharan African countries have succeeded in reducing wealth-related inequalities in the coverage of reproductive, maternal, newborn and child health interventions. METHODS We analysed survey data from 36 countries, grouped into Central, East, Southern and West Africa subregions, in which at least two surveys had been conducted since 1995. We calculated the composite coverage index, a function of essential maternal and child health intervention parameters. We adopted the wealth index, divided into quintiles from poorest to wealthiest, to investigate wealth-related inequalities in coverage. We quantified trends with time by calculating average annual change in index using a least-squares weighted regression. We calculated population attributable risk to measure the contribution of wealth to the coverage index. FINDINGS We noted large differences between the four regions, with a median composite coverage index ranging from 50.8% for West Africa to 75.3% for Southern Africa. Wealth-related inequalities were prevalent in all subregions, and were highest for West Africa and lowest for Southern Africa. Absolute income was not a predictor of coverage, as we observed a higher coverage in Southern (around 70%) compared with Central and West (around 40%) subregions for the same income. Wealth-related inequalities in coverage were reduced by the greatest amount in Southern Africa, and we found no evidence of inequality reduction in Central Africa. CONCLUSION Our data show that most countries in sub-Saharan Africa have succeeded in reducing wealth-related inequalities in the coverage of essential health services, even in the presence of conflict, economic hardship or political instability.
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Affiliation(s)
- Fernando C Wehrmeister
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3 piso, Pelotas, Brazil
| | - Cheikh Mbacké Fayé
- African Population and Health Research Centre, West Africa Regional Office, Dakar, Senegal
| | - Inácio Crochemore M da Silva
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3 piso, Pelotas, Brazil
| | - Agbessi Amouzou
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America (USA)
| | - Leonardo Z Ferreira
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3 piso, Pelotas, Brazil
| | - Safia S Jiwani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America (USA)
| | | | - Martin Mutua
- African Population and Health Research Center, Central Office, Nairobi, Kenya
| | - Abdoulaye Maïga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America (USA)
| | - Tome Ca
- Health Information System, West African Health Organization, Bobo-Dioulasso, Burkina Faso
| | - Estelle Sidze
- African Population and Health Research Center, Central Office, Nairobi, Kenya
| | - Chelsea Taylor
- Department of Data and Analytics, World Health Organization, Geneva, Switzerland
| | - Kathleen Strong
- Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Liliana Carvajal-Aguirre
- Division of Data, Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, USA
| | - Tyler Porth
- Division of Data, Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, USA
| | | | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3 piso, Pelotas, Brazil
| | - Ties Boerma
- Centre for Global Public Health, University of Manitoba, Canada
| | - on the behalf of the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health regional collaboration in sub-Saharan Africa
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3 piso, Pelotas, Brazil
- African Population and Health Research Centre, West Africa Regional Office, Dakar, Senegal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America (USA)
- Centre for Global Public Health, University of Manitoba, Canada
- African Population and Health Research Center, Central Office, Nairobi, Kenya
- Health Information System, West African Health Organization, Bobo-Dioulasso, Burkina Faso
- Department of Data and Analytics, World Health Organization, Geneva, Switzerland
- Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
- Division of Data, Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, USA
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