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Kampalath V, Tarnas MMC, Patel MV, Hamze M, Loutfi R, Tajaldin B, Albik A, Kassas A, Khashata A, Abbara A. An analysis of paediatric clinical presentations in Northwest Syria and the effect of forced displacement, 2018-2022. GLOBAL EPIDEMIOLOGY 2024; 8:100146. [PMID: 38947221 PMCID: PMC11214201 DOI: 10.1016/j.gloepi.2024.100146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Background One in six children worldwide lives in a region exposed to armed conflict. In conflicts, children are among the most vulnerable, and at risk of adverse health outcomes. We sought to describe trends in child and adolescent morbidity in northwest Syria (NWS) and understand how forced displacement affects clinical utilisation during the Syrian conflict. Methods Retrospective data between January 2018 and December 2022 were obtained from the Syrian American Medical Society (SAMS), a non-governmental organisation that operates health facilities in NWS. After initial descriptive analyses were completed, we performed a seasonal-trend decomposition to estimate the seasonality of clinical presentations. We subsequently employed a multivariate regression model incorporating age, gender, residency status, season, and a random district-level intercept to measure the association between the odds of clinical consultation and forced displacement. Findings Across 51 reporting SAMS facilities, 2,687,807 clinical consultations were studied over a five-year period. Seasonality was demonstrated for every clinical consultation category. Higher levels of forced displacement were associated with increased odds of consultations for nutrition, trauma, NCDs and mental health and decreased odds of consultation for communicable diseases. Aside from traumatic injury, internally displaced persons (IDPs) had higher AORs of clinical consultations compared to host populations. Interpretation Forced displacement differentially impacts clinical utilisation among children in northwest Syria, and the effects of displacement persist for at least six months. Clinical needs vary by host/IDP status, sex, age, and season. This study can assist policymakers in forecasting the health needs of children in northwest Syria.
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Affiliation(s)
- Vinay Kampalath
- Perelman School of Medicine, University of Pennsylvania, USA
| | - Ms Maia C. Tarnas
- Department of Population Health and Disease Prevention, University of California Irvine, USA
| | | | - Mohamed Hamze
- Syrian American Medical Society, Washington, DC, USA
| | - Randa Loutfi
- Syrian American Medical Society, Washington, DC, USA
| | | | - Ahmad Albik
- Syrian American Medical Society, Washington, DC, USA
| | - Ayman Kassas
- Syrian American Medical Society, Washington, DC, USA
| | - Anas Khashata
- Syrian American Medical Society, Washington, DC, USA
| | - Aula Abbara
- Imperial College, London, UK
- Syrian American Medical Society, Washington, DC, USA
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Lumey LH, Li C, Khalangot M, Levchuk N, Wolowyna O. Fetal exposure to the Ukraine famine of 1932-1933 and adult type 2 diabetes mellitus. Science 2024; 385:667-671. [PMID: 39116227 DOI: 10.1126/science.adn4614] [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: 12/11/2023] [Accepted: 06/07/2024] [Indexed: 08/10/2024]
Abstract
The short-term impact of famines on death and disease is well documented, but estimating their potential long-term impact is difficult. We used the setting of the man-made Ukrainian Holodomor famine of 1932-1933 to examine the relation between prenatal famine and adult type 2 diabetes mellitus (T2DM). This ecological study included 128,225 T2DM cases diagnosed from 2000 to 2008 among 10,186,016 male and female Ukrainians born from 1930 to 1938. Individuals who were born in the first half-year of 1934, and hence exposed in early gestation to the mid-1933 peak famine period, had a greater than twofold likelihood of T2DM compared with that of unexposed controls. There was a dose-response relationship between severity of famine exposure and increase in adult T2DM risk.
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Affiliation(s)
- L H Lumey
- Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
- Leiden University Medical Center, 2300 RC Leiden, Netherlands
| | - Chihua Li
- Institute of Chinese Medical Sciences, University of Macau, Macao SAR 999078, China
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48109, USA
- Johns Hopkins University, Baltimore, MD 21218, USA
| | - Mykola Khalangot
- Komisarenko Institute of Endocrinology and Metabolism, Kyiv 04114, Ukraine
- Shupyk National Healthcare University, Kyiv 04112, Ukraine
| | - Nataliia Levchuk
- Ptoukha Institute of Demography and Social Studies, Kyiv 01032, Ukraine
- Max Planck Institute for Demographic Research, 18057 Rostock, Germany
| | - Oleh Wolowyna
- Center for Slavic, Eurasian and Eastern European Studies, University of North Carolina, Chapel Hill, NC 27516, USA
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Kodo TK, Kidie AA, Merecho TH, Tiruneh MG, Yayeh BM, Getaneh BA, Demesie AM, Wendimagegn ZS. The Impact of Armed Conflict on Services and Outcomes Related to Maternal and Reproductive Health in North Wollo, Amhara, Ethiopia: A Qualitative Study. Int J Womens Health 2024; 16:1055-1066. [PMID: 38863520 PMCID: PMC11166144 DOI: 10.2147/ijwh.s457529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/28/2024] [Indexed: 06/13/2024] Open
Abstract
Introduction Armed conflict is a public health problem that poses a serious challenge to the health system. Maternal and reproductive health is among the most affected areas. Maternal death rates were highest in conflict-affected countries. Sexual violence and rape are commonplaces, which contributes to the rise in the number of unwanted pregnancies. Reliable data related to the health of mothers and reproduction is required to inform public health policies. Therefore, this study aimed to assess the impact of armed conflict on services and outcomes related to maternal and reproductive health. Objective To explore the impact of armed conflict on services and outcomes related to maternal and reproductive health in North Wollo, Amhara, and Ethiopia by 2022. Methods This study used an institutional and community-based exploratory design. Six focus group discussions and 44 in-depth interviews were conducted with healthcare professionals, administrators, women, and Non Governmental Organization workers. Each item was recorded in audio, verbatim transcription was made and converted into English. By using OpenCode version 4.03 thematic analyses was performed. Results Three overarching themes were identified. The first theme was the inadequate standards of maternal and reproductive health services. This includes the breakdown of infrastructure, shortages of medicines and medical supplies, and the lack of sterility of available limited materials and procedures. The second theme was poor maternal and reproductive health status. It includes poor pregnancy, delivery, reproductive and fertility-related health outcomes. The last theme was the limited access to maternal and reproductive services. Conclusion Armed conflicts have enormous effects on services and results related to the health of mothers and reproductive processes. Addressing these effects is essential for designing and implementing public health measures to improve services related to the health of mothers and the reproductive system.
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Affiliation(s)
- Tsion Kokeb Kodo
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Atitegeb Abera Kidie
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Tilahun Hailu Merecho
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, College Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berihun Mulu Yayeh
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
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Tsadik M, Legesse AY, Teka H, Abraha HE, Fisseha G, Ebrahim MM, Berhe B, Hadush MY, Gebrekurstos G, Ayele B, Tsegay H, Gebremeskel T, Gebremariam T, Hagos T, Gebreegziabher A, Muoze K, Mulugeta A, Gebregziabher M, Godefay H. Neonatal mortality during the war in Tigray: a cross-sectional community-based study. Lancet Glob Health 2024; 12:e868-e874. [PMID: 38614634 DOI: 10.1016/s2214-109x(24)00057-3] [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: 03/30/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Neonatal mortality is among the key national and international indicators of health services. The global Sustainable Development Goal target for neonatal mortality is fewer than 12 deaths per 1000 livebirths, by 2030. Neonatal mortality estimates in the 2019 Ethiopian Demographic Health Survey found 25·7 deaths per 1000 livebirths. Subnational surveys specific to Tigray, Ethiopia, reported a neonatal mortality lifetime prevalence of 7·13 deaths. Another government report from the Tigray region estimated a neonatal mortality rate of ten deaths per 1000 livebirths in 2020. Despite the numerous interventions in Ethiopia's Tigray region to achieve the Sustainable Development Goals, the war has disrupted most health services, but the effect on neonatal mortality is unknown. Thus, this study aimed to investigate the magnitude and causes of neonatal mortality during the war in Tigray. METHODS A cross-sectional community-based study was conducted in Tigray to evaluate neonatal mortality that occurred from Nov 4, 2020, to May 30, 2022. Among the 31 districts, 121 tabias were selected using computer-generated random sampling, and 189 087 households were visited. We adopted a validated WHO 2022 verbal autopsy tool, and data were collected using an interviewer-administrated Open Data Kit. In the absence of the mother, other respondents to the verbal autopsy interview were household members aged 18 years and older who provided care during the final illness that led to death. FINDINGS 29 761 livebirths were recorded during the screening of 189 087 households. Verbal autopsy was administered for 1158 households with neonatal deaths. 317 neonates were stillborn, and 841 neonatal deaths were recorded with the WHO 2022 verbal autopsy tool from Nov 4, 2020, to May 30, 2022, in 31 districts. The neonatal mortality rate was 28·2 deaths per 1000 livebirths. 476 (57%) of the 841 neonatal deaths occurred at home and 296 (35%) in health facilities. A high rate of neonatal deaths was reported in rural districts (80% [673 of 841]) compared with urban districts (20% [168 of 841]), and 663 (79%) deaths occurred during the early neonatal period, in the first week of life (0-6 days). The leading causes of neonatal death were asphyxia (35% [291 of 834]), prematurity (30% [247 of 834]), and infection (12% [104 of 834]). Asphyxia (37% [246 of 663]) and infection (28% [50 of 178]) were the leading causes of death for early and late neonatal period deaths, respectively. INTERPRETATION Neonatal mortality in Tigray is high due to preventable causes. An urgent response is needed to prevent the high number of neonatal deaths associated with the depleted health resources and services resulting from the war, and to achieve the Sustainable Development Goal on neonatal mortality. FUNDING UNICEF and United Nations Fund for Population Activities. TRANSLATION For the Tigrigna translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Mache Tsadik
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia.
| | - Awol Yemane Legesse
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Hale Teka
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Hiluf Ebuy Abraha
- Hospital Quality, Ayder Comprehensive Specialized Hospital, Mekelle University, Tigray, Ethiopia; Department of Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Girmatsion Fisseha
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | - Bereket Berhe
- School of Medicine, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Martha Yemane Hadush
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | | | - Brhane Ayele
- Tigray Health Research Institute, Tigray, Ethiopia
| | - Haile Tsegay
- Maternal and Child Health, Tigray Regional Health Bureau, Tigray, Ethiopia
| | - Tesfit Gebremeskel
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Tsega Gebremariam
- Department of Obstetrics and Gynecology, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Tigist Hagos
- Department of Reproductive Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Abraha Gebreegziabher
- Department of Pediatrics and Child Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Kibrom Muoze
- School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Afewerk Mulugeta
- Department of Nutrition and Dietetics, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Hagos Godefay
- Maternal and Child Health, Tigray Regional Health Bureau, Tigray, Ethiopia
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Ngarmbatedjimal A, Abdelaziz M, Allambademel VDP, Diarra A, Djerambete V, Kodjimadje T, Luketa S, Madjigoto R, Miangotar Y, Ndingayande A, Tamira S, Varelis T, Vourbane K, Casey SE. Refugee women's and providers' perceptions of person-centered maternity care: a qualitative study in two refugee camps in Chad. BMC Pregnancy Childbirth 2024; 24:225. [PMID: 38561681 PMCID: PMC10983620 DOI: 10.1186/s12884-024-06424-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Globally, mistreatment of women during labor and delivery is a common human rights violation. Person-centered maternity care (PCMC), a critical component of quality of care, is respectful and responsive to an individual's needs and preferences. Factors related to poor PCMC are often exacerbated in humanitarian settings. METHODS We conducted a qualitative study to understand Sudanese refugee women's experiences, including their perceptions of quality of care, during labor and delivery at the maternities in two refugee camps in eastern Chad, as well as maternity health workers' perceptions of PCMC and how they could be better supported to provide this. In-depth interviews were conducted individually with 22 women who delivered in the camp maternities and five trained midwives working in the two maternities; and in six dyads with a total of 11 Sudanese refugee traditional birth attendants and one assistant midwife. In addition, facility assessments were conducted at each maternity to determine their capacity to provide PCMC. RESULTS Overall, women reported positive experiences in the camp maternities during labor and delivery. Providers overwhelmingly defined respectful care as patient-centered and respect as being something fundamental to their role as health workers. While very few reported incidents of disrespect between providers and patients in the maternity, resource constraints, including overwork of the providers and overcrowding, resulted in some women feeling neglected. CONCLUSIONS Despite providers' commitment to offering person-centered care and women's generally positive experiences in this study, one of few that explored PCMC in a refugee camp, conflict and displacement exacerbates the conditions that contribute to mistreatment during labor and delivery. Good PCMC requires organizational emphasis and support, including adequate working conditions and ensuring suitable resources so health workers can effectively perform.
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Affiliation(s)
- Alexis Ngarmbatedjimal
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Mahamat Abdelaziz
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Vincent de Paul Allambademel
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Aminata Diarra
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, NY, 10032, USA
| | - Valentin Djerambete
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Thérèse Kodjimadje
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Samy Luketa
- International Rescue Committee Chad, BP 5208, N'Djaména, Chad
| | - Robert Madjigoto
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Yodé Miangotar
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | | | - Salomon Tamira
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Theodora Varelis
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, NY, 10032, USA
| | | | - Sara E Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, NY, 10032, USA.
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Alsharif A, Almatary AM, Ahmed F, Badheeb M. Perinatal Birth Asphyxia Among Newborns at Jiblah Public Health Hospital in Ibb City, Yemen, During Six Years of Conflict and Its Predictive Factors: A Retrospective Cross-Sectional Study. Cureus 2024; 16:e54100. [PMID: 38487157 PMCID: PMC10938086 DOI: 10.7759/cureus.54100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Birth asphyxia is a major cause of infant death across the world, especially in developing countries, where the issue is significantly underreported and underestimated, particularly in fragile and conflict-affected states. OBJECTIVE The purpose of this study was to determine the prevalence and risk factors for birth asphyxia in women at Jiblah University Hospital in Ibb, Yemen, and its predictive factors throughout six years of conflict. METHOD We conducted a retrospective cross-sectional chart review and analysis of the birth database spanning from June 2013 to September 2019 at Jiblah University Hospital in Ibb, Yemen. We used APGAR (appearance, pulse, grimace, activity, and respiration) scores <7 at both the first- and fifth-minute post-delivery with umbilical cord arterial blood pH <7 (metabolic acidosis) and/or neurologic manifestations (seizures or an altered tone) within the first 24 hours of life to define birth asphyxia cases. Factors associated with birth asphyxia were analyzed using univariate and multivariate regression analysis with an odds ratio (OR) and 95% confidence interval (CI). RESULTS A total of 5,193 neonates were delivered during the study period. The prevalence of birth asphyxia in 309 (6%) neonates. In a multivariate analysis, illiteracy (OR: 2.90; 95% CI: 0.98-8.41), referred mothers (OR: 3.04; 95% CI: 1.42-6.40), advanced maternal age (OR: 1.05; 95% CI: 1.02-1.07), home delivery (OR: 6.50; 95% CI: 3.09-12.57), prematurity (OR: 1.43; 95% CI: 1.05-1.93), and low birth weight (OR: 3.09; 95% CI: 1.93-4.93) were predictors for birth asphyxia and were statistically significant (p<0.05). CONCLUSION In this study, the prevalence of birth asphyxia was equivalent to that of other underdeveloped nations. However, continual attention and treatments are required to lower the risk of birth asphyxia. Illiteracy, referred mothers, advanced maternal age, home delivery, prematurity, and low birth weight were all predictors of birth asphyxia in this research. Most birth asphyxia factors mentioned in this study can be managed through effective prenatal, intrapartum, and postpartum care, as well as a strict following of national obstetrics and neonatal guidelines.
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Affiliation(s)
- Afaf Alsharif
- Gynecology, Jibla University for Medical and Health Sciences, Ibb, YEM
| | | | | | - Mohamed Badheeb
- Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USA
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Liu R, Pi L, Leng F, Shen Q. Global disability-adjusted life years and deaths attributable to child and maternal malnutrition from 1990 to 2019. Front Public Health 2024; 12:1323263. [PMID: 38304181 PMCID: PMC10830744 DOI: 10.3389/fpubh.2024.1323263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Background Child and maternal malnutrition (CMM) caused heavy disability-adjusted life years (DALY) and deaths globally. It is crucial to understand the global burden associated with CMM in order to prioritize prevention and control efforts. We performed a comprehensive analysis of the global DALY and deaths attributable to CMM from 1990 to 2019 in this study. Methods The age-standardized CMM related burden including DALY and death from 1990 to 2019 were accessed from the Global Burden of Disease study 2019 (GBD 2019). The changing trend were described by average annual percentage change (AAPC). The relationship between sociodemographic factors and burden attributable to CMM were explored by generalized linear model (GLM). Results Globally, in 2019, the age-standardized DALY and death rates of CMM were 4,425.24/100,000 (95% UI: 3,789.81/100,000-5,249.55/100,000) and 44.72/100,000 (95% UI: 37.83/100,000-53.47/100,000), respectively. The age-standardized DALY rate (AAPC = -2.92, 95% CI: -2.97% to -2.87%) and death rates (AAPC = -3.19, 95% CI: -3.27% to -3.12%) presented significantly declining trends during past 30 years. However, CMM still caused heavy burden in age group of <28 days, Sub-Saharan Africa and low SDI regions. And, low birth weight and short gestation has identified as the primary risk factors globally. The GLM indicated that the highly per capita gross domestic product, per capita current health expenditure, physicians per 1,000 people were contributed to reduce the burden attributable to CMM. Conclusion Although global burden attributable to CMM has significantly declined, it still caused severe health burden annually. To strengthen interventions and address resources allocation in the vulnerable population and regions is necessary.
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Affiliation(s)
- Rong Liu
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Lucheng Pi
- Shenzhen Bao’an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Fangqun Leng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Qing Shen
- School of Public Health, Hangzhou Medical College, Hangzhou, China
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Homer CSE. End humanitarian catastrophe in conflict settings. Lancet 2024; 403:24-25. [PMID: 38071987 DOI: 10.1016/s0140-6736(23)02695-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/08/2024]
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Hedström J, Herder T. Women's sexual and reproductive health in war and conflict: are we seeing the full picture? Glob Health Action 2023; 16:2188689. [PMID: 36927249 PMCID: PMC10026773 DOI: 10.1080/16549716.2023.2188689] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
It is well established that women's sexual and reproductive health (SRHR) is negatively affected by war. While global health research often emphasises infrastructure and systematic factors as key impediments to women's SRHR in war and postwar contexts, reports from different armed conflicts indicate that women's reproduction may be controlled both by state and other armed actors, limiting women's choices and access to maternal and reproductive health care even when these are available. In addition, it is important to examine and trace disparities in sexual reproductive health access and uptake within different types of wars, recognising gendered differences in war and postwar contexts. Adding feminist perspectives on war to global health research explanations of how war affects women's sexual and reproductive health might then contribute to further understanding the complexity of the different gendered effects war and armed conflicts have on women's sexual and reproductive health.
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Affiliation(s)
- Jenny Hedström
- Department of War Studies and Military History, Swedish Defence University, Stockholm, Sweden
| | - Tobias Herder
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Rostomian L, Chiloyan A, Hentschel E, Messerlian C. Effects of armed conflict on maternal and infant health: a mixed-methods study of Armenia and the 2020 Nagorno-Karabakh war. BMJ Open 2023; 13:e076171. [PMID: 38159954 PMCID: PMC10759127 DOI: 10.1136/bmjopen-2023-076171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Armed conflict worldwide and across history has harmed the health of populations directly and indirectly, including generations beyond those immediately exposed to violence. The 2020 war between Armenia and Azerbaijan over Nagorno-Karabakh, inhabited by an ethnically Armenian population, provides an example of how conflict harmed health during COVID-19. We hypothesised that crises exposure would correspond to decreased healthcare utilisation rates and worse health outcomes for the maternal and infant population in Armenia, compounded during the pandemic. METHODS Following a mixed-methods approach, we used ecological data from 1980 to 2020 to evaluate health trends in conflict, measured as battle-related deaths (BRDs), COVID-19 cases, and maternal and infant health indicators during periods of conflict and peace in Armenia. We also interviewed 10 key informants about unmet needs, maternal health-seeking behaviours and priorities during the war, collecting recommendations to mitigate the effects of future crisis on maternal and infant health. We followed a deductive coding approach to analyse transcripts and harvest themes. RESULTS BRDs totalled more in the 2020 war compared with the previous Nagorno-Karabakh conflicts. Periods of active conflict between 1988-2020 were associated with increased rates of sick newborn mortality, neonatal mortality and pre-eclampsia or eclampsia. Weekly average COVID-19 cases increased sevenfold during the 2020 Nagorno-Karabakh war. Key informants expressed concerns about the effects of stress and grief on maternal health and pregnancy outcomes and recommended investing in healthcare system reform. Participants also stressed the synergistic effects of the war and COVID-19, noting healthcare capacity concerns and the importance of a strong primary care system. CONCLUSIONS Maternal and infant health measures showed adverse trends during the 2020 Nagorno-Karabakh war, potentially amplified by the concurrent COVID-19 pandemic. To mitigate effects of future crises on population health in Armenia, informants recommended investments in healthcare system reform focused on primary care and health promotion.
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Affiliation(s)
- Lara Rostomian
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Araz Chiloyan
- Ministry of Health of the Republic of Armenia, Yerevan, Armenia
| | - Elizabeth Hentschel
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Carmen Messerlian
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital Vincent Center for Reproductive Biology, Boston, Massachusetts, USA
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Ross T, de Maria de Albuquerque C, Chaves J, Carneiro Rolim KM, Albuquerque Frota M, Surkan PJ. COVID-19 threatens the progress of humanised childbirth: a qualitative study of giving birth during the pandemic in Brazil. Sex Reprod Health Matters 2023; 31:2152548. [PMID: 36825627 PMCID: PMC9970195 DOI: 10.1080/26410397.2022.2152548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The stressful nature of the early months of the COVID-19 pandemic severely impacted the quality of maternity care. The purpose of this study was to understand and explore the labour and delivery experiences for women who were diagnosed with COVID-19 in Brazil during this time. Between July and October 2020, we conducted 28 semi-structured interviews with postpartum women who tested positive for COVID-19 prior to delivering at a tertiary hospital in Fortaleza, Brazil. Interview transcripts were coded, and we carried out a thematic analysis using three domains of the World Health Organization's model of intrapartum care for a positive childbirth experience as a framework. During labour and delivery, women experienced varying levels of respect, with many women reporting feeling mistreated by their healthcare team because of their COVID-19 diagnosis. Due to COVID-19 hospital protocols that denied companions or visitors, women reported feeling unsupported and isolated, especially during the mandatory quarantine. Women also experienced varying levels of effective communication, with some women citing they felt the staff were often fearful, and either avoidant or disrespectful. A minority of women reported that the staff appeared to be respectful and receptive to their needs. Our findings provide preliminary evidence that the strain of the COVID-19 pandemic on health professionals potentially results in ineffective communication and mistreatment during labour and delivery. Embedding respectful and humanised childbirth principles into emergency maternal healthcare protocols may improve the childbirth experience for women with COVID-19, as well as for women during future public health emergencies.
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Affiliation(s)
- Tamia Ross
- MSPH Student, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Conceição de Maria de Albuquerque
- PhD Student, Centro de Ciências de Saúde, Programa de Pós-graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Jessica Chaves
- MS Student, Centro de Ciências de Saúde, Programa de Pós-graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Karla Maria Carneiro Rolim
- Professor, Centro de Ciências de Saúde, Programa de Pós-graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Mirna Albuquerque Frota
- Professor, Centro de Ciências de Saúde, Programa de Pós-graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Pamela J. Surkan
- Professor, Social and Behavioral Intervention Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5523, Baltimore, MD, USA. Correspondence:
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Berhan Y, Assefa B, Tassew A, Mengiste W, Gebreyesus A, Geletu Z, Muluneh K, Asfaw G, Abera S, Negesso A, Abebe S, Abelneh H, Deju E, Mathewos T. The Protracted Civil and Armed Conflicts in Ethiopia Fueling the COVID-19-Related Health Crisis: Perspective on Building a Resilient Health System to Shocks. Ethiop J Health Sci 2023; 33:869-880. [PMID: 38784511 PMCID: PMC11111203 DOI: 10.4314/ejhs.v33i5.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/31/2023] [Indexed: 05/25/2024] Open
Abstract
Prior to the intensified civil and armed conflicts in Ethiopia, remarkable progress was made in the health sector, which has persuaded the Ministry of Health to give special focus on building a responsive and resilient health system in the second five-year health sector transformation plan (HSTP II 2021-2025). However, the years-long civil and armed conflicts have been fueling the COVID-19 crisis and have caused multi-sectoral infrastructure damage, human life loss, and economic crisis. In 2021 alone, the conflict causes more than five million internal displacements of persons (IDP) and thousands civilian deaths. Review of reported government data has shown that 3,508 health posts, 750 health centers, and 76 hospitals were partially or completely damaged in four regions. Looting of medical equipment and facilities for amenities was devastating. More than 19 million people were affected by the armed and civil conflicts between 2020 and 2021. Unless peace is ensured across the nation the sooner possible, it is foreseen that the devastation may further worsen, and recovery may be a far-fetched possibility. Therefore, in addition to restoration of the disrupted health services, it is the right time for the Ministry of Health to incorporate the humanitarian-development nexus as a joint strategy with the Disaster Prevention and Preparedness Commission (DPPC) to ensure a resilient health system for similar multifaceted conflict-related health crisis, disasters, and infectious outbreaks.
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Perera SM, Isa GP, Sebushishe A, Sundararaj P, Piccirillo M, Xia S, Langaigne A, Ali J, Casey SE. "Midwives are heroes of the country": qualitative evaluation of a midwifery education program in South Sudan. Front Glob Womens Health 2023; 4:1215405. [PMID: 37705530 PMCID: PMC10497107 DOI: 10.3389/fgwh.2023.1215405] [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: 05/01/2023] [Accepted: 08/16/2023] [Indexed: 09/15/2023] Open
Abstract
Background Countries affected by armed conflict have higher maternal mortality than stable settings. South Sudan has one of the highest maternal mortality ratios in the world, with an estimated 789 maternal deaths per 100,000 live births. Long-term socio-political instability has contributed to significant challenges in its health system. To reduce maternal and newborn morbidity and mortality, South Sudan must increase the number of skilled midwives. Methods A cross-sectional mixed methods study was conducted in 2022 to assess the midwifery education program at three schools receiving support from International Medical Corps in South Sudan, including in-depth interviews with 15 midwifery school graduates currently working as midwives, their supervisors, 16 school faculty (in dyads), and two Ministry of Health officials; and nine focus group discussions with women clients of graduate midwives. Results Participants identified strengths of the schools, including being well equipped with trained and competent teaching staff, competency-based curriculum, including practical training which prepared graduate midwives to apply their skills in practice. Weaknesses of the program included its dependence on donor funding, inadequate mentorship and number of tutors, and insufficient practice for some services due to low client load at clinical sites. Additionally, participants identified challenges affecting midwives' ability to provide good quality care, including lack of equipment and supplies, low client load, low salaries, and insecurity due to conflict. Nevertheless, women in the community appreciated the immense work that midwives do. Midwives were respected by the community at large, and graduates expressed pride and satisfaction in their job, as well as the positive impact they have had in providing critical services to communities. Discussion Overall, the quality of the midwifery education program appears to be strong, however gaps in the program and the provision of quality care remain. The findings highlight the need to ensure sustained funding for midwifery education, as well as health system strengthening to ensure midwives can practice their skills. Continued investment in midwifery education and training is critical to reduce high maternal mortality and morbidity in South Sudan.
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Affiliation(s)
| | | | | | - Preethika Sundararaj
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Megan Piccirillo
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Shanell Xia
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Amaya Langaigne
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Javed Ali
- International Medical Corps, Washington, DC, United States
| | - Sara E. Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States
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Zhang T, He Q, Richardson S, Tang K. Does armed conflict lead to lower prevalence of maternal health-seeking behaviours: theoretical and empirical research based on 55 683 women in armed conflict settings. BMJ Glob Health 2023; 8:e012023. [PMID: 37612034 PMCID: PMC10450136 DOI: 10.1136/bmjgh-2023-012023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/25/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Women and children bear a substantial burden of morbidity and mortality due to armed conflict. Life-saving maternal and child health (MCH) services are low-quality in most conflict-affected regions. Previous studies on armed conflict and MCH services have been mostly cross-sectional, and a causal relationship between armed conflict and MCH services utilisation cannot be inferred. METHODS First, we constructed a utility equation for maternal health-seeking behaviour. Next, we extracted MCH data from the Multiple Indicator Cluster Survey led by the UNICEF. Armed conflict data were obtained from the Uppsala Conflict Data Programme; 55 683 women aged 15-49 from Chad, the Central African Republic, the Democratic Republic of Congo (DRC) and the Republic of Iraq were selected as participants. We fitted a difference-in-differences (DID) model, taking before or after the conflict started as an exposure variable to estimate the effects of armed conflict on maternal health-seeking behaviours. RESULTS According to the results of the DID model, in the regional sample, armed conflict had a positive effect on tetanus vaccination (β=0.055, 95% CI 0.004 to 0.106, p<0.05), and had a negative effect on antenatal care at least eight visits (ANC8+) (β=-0.046, 95% CI -0.078 to -0.015, p<0.01). And, the effects of armed conflict on ANC, ANC4+, institutional delivery and early initiation of breast feeding (EIB) were not statistically significant. As for the country sample, we found that armed conflict had a negative effect on EIB (β=-0.085, 95% CI -0.184 to 0.015, p<0.1) in Chad. In Iraq, armed conflict had positive impacts on ANC (β=0.038, 95% CI -0.001 to 0.078, p<0.1) and tetanus vaccination (β=0.059, 95% CI 0.012 to 0.107, p<0.05), whereas it had a negative effect on ANC8+ (β=-0.039, 95% CI -0.080 to 0.002, p<0.1). No statistically significant associations were discovered in DRC based on the DID model. CONCLUSIONS There might be a mixed effect of armed conflict on maternal health-seeking behaviours. In the absence of humanitarian assistance, armed conflict reduces certain maternal health-seeking behaviours, such as ANC8+. When practical humanitarian health assistance is provided, the damage can be alleviated, and even the prevalence of maternal health-seeking behaviours can be improved, such as tetanus vaccination. Providing humanitarian assistance to conflict-affected regions improved the accessibility of MCH services for women living in those areas. However, the goals of saving lives and alleviating suffering still need to be achieved. In conflict-affected regions, humanitarian assistance on ANC, institutional delivery and breast feeding need strengthening.
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Affiliation(s)
- Tingkai Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Qiwei He
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute of International Development Cooperation, Chinese Academy of International Trade and Economic Cooperation, Beijing, China
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Man I, Georges D, Sankaranarayanan R, Basu P, Baussano I. Building resilient cervical cancer prevention through gender-neutral HPV vaccination. eLife 2023; 12:e85735. [PMID: 37486822 PMCID: PMC10365835 DOI: 10.7554/elife.85735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/08/2023] [Indexed: 07/26/2023] Open
Abstract
The COVID-19 pandemic has disrupted HPV vaccination programmes worldwide. Using an agent-based model, EpiMetHeos, recently calibrated to Indian data, we illustrate how shifting from a girls-only (GO) to a gender-neutral (GN) vaccination strategy could improve the resilience of cervical cancer prevention against disruption of HPV vaccination. In the base case of 5-year disruption with no coverage, shifting from GO to GN strategy under 60% coverage (before disruption) would increase the resilience, in terms of cervical cancer cases still prevented in the disrupted birth cohorts per 100,000 girls born, by 2.8-fold from 107 to 302 cases, and by 2.2-fold from 209 to 464 cases under 90% coverage. Furthermore, shifting to GN vaccination helped in reaching the World Health Organization (WHO) elimination threshold. Under GO vaccination with 60% coverage, the age-standardised incidence rate of cervical cancer in India in the long term with vaccination decreased from 11.0 to 4.7 cases per 100,000 woman-years (above threshold), as compared to 2.8 cases (below threshold) under GN with 60% coverage and 2.4 cases (below threshold) under GN with 90% coverage. In conclusion, GN HPV vaccination is an effective strategy to improve the resilience to disruption of cancer prevention programmes and to enhance the progress towards cervical cancer elimination.
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Affiliation(s)
- Irene Man
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections BranchLyonFrance
| | - Damien Georges
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections BranchLyonFrance
| | | | - Partha Basu
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections BranchLyonFrance
| | - Iacopo Baussano
- International Agency for Research on Cancer (IARC/WHO), Early Detection, Prevention and Infections BranchLyonFrance
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Sambo J, Chicumbe S, de Deus N, Gonçalves L. Quality of routine data for monitoring nutrition and diarrhoea indicators of children under 5 in Mozambique: an ecological study over a 5-year period. BMJ Open 2023; 13:e073239. [PMID: 37479521 PMCID: PMC10364158 DOI: 10.1136/bmjopen-2023-073239] [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: 07/23/2023] Open
Abstract
BACKGROUND Undernutrition and diarrhoea have a high burden in children under 5 in low/middle-income countries. Having data-driven quality health services for these two diseases is key in order to address the high burden of diseases; therefore, health systems must provide data to monitor, manage, plan and decide on policies at all levels of health services. OBJECTIVE We aimed to assess the quality of nutrition and diarrhoea routine data on children under 5 in Mozambique. DESIGN A longitudinal ecological study was implemented. Secondary data were used to assess the quality of moderate acute malnutrition (MAM), deworming and rotavirus vaccine indicators based on the data's completeness, presence of outliers and consistency, and seasonality analysis in the form of time series analysis was performed. SETTING We used monthly district-level count data from 2017 to 2021, from all health facilities, from the Mozambican health information system (Sistema de Informação de Saúde para Monitoria e Avaliação, or District Health Information System version 2). RESULTS The rotavirus vaccine indicators presented better completeness when compared with other indicators under analysis. Extreme outliers were observed for deworming and rotavirus vaccines, with a higher number of outliers in the Zambezia and Nampula Provinces. Better consistency over time was observed when analysing the period before the COVID-19 pandemic, for all of the indicators and across provinces. Indicators of MAM and MAM-recovered showed more consistency issues over time in both periods of 2017-2019 and 2018-2021. In terms of seasonality analysis, for the MAM and MAM-recovered indicators, lower variation was observed, and heterogeneous patterns were seen across provinces for the rotavirus vaccine, which had the most pronounced negative seasonality components in Maputo City. CONCLUSION Major deficits regarding the analysed quality indicators were observed for Cabo Delgado, Nampula, Zambezia, Tete, Manica, and Maputo City and Province.
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Affiliation(s)
- Júlia Sambo
- Instituto Nacional de Saúde, Maputo, Mozambique
- Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sérgio Chicumbe
- Instituto Nacional de Saúde, Maputo, Mozambique
- Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nilsa de Deus
- Instituto Nacional de Saúde, Maputo, Mozambique
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Luzia Gonçalves
- Universidade Nova de Lisboa, Lisbon, Portugal
- Universidade de Lisboa, Lisbon, Portugal
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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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Pasquier E, Owolabi OO, Fetters T, Ngbale RN, Adame Gbanzi MC, Williams T, Chen H, Fotheringham C, Lagrou D, Schulte-Hillen C, Powell B, Baudin E, Filippi V, Benova L. High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study). BMC Pregnancy Childbirth 2023; 23:143. [PMID: 36871004 PMCID: PMC9985077 DOI: 10.1186/s12884-023-05427-6] [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: 05/31/2022] [Accepted: 02/03/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). METHODS We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records' reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. RESULTS We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). CONCLUSION Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.
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Affiliation(s)
- Estelle Pasquier
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France. .,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. .,Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium.
| | - Onikepe O Owolabi
- Guttmacher Institute, New York, USA.,Vital Strategies, New York, USA
| | | | - Richard Norbert Ngbale
- Ministère de la santé et de la Population de la République Centrafricaine, Bangui, Central African Republic
| | | | | | - Huiwu Chen
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France
| | | | | | | | | | - Elisabeth Baudin
- Epicentre - Médecins Sans Frontières, 34, avenue Jean Jaurès, 75019, Paris, France
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health - London School of Hygiene and Tropical Medicine, London, UK
| | - Lenka Benova
- Department of Public Health - Institute of Tropical Medicine, Antwerp, Belgium
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Hameed MA, Rahman MM, Khanam R. The health consequences of civil wars: evidence from Afghanistan. BMC Public Health 2023; 23:154. [PMID: 36690962 PMCID: PMC9872361 DOI: 10.1186/s12889-022-14720-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/24/2022] [Indexed: 01/24/2023] Open
Abstract
This study examines the effects of long-run civil wars on healthcare, which is an important component of human capital development and their causality nexus in Afghanistan using the MVAR (modified vector autoregressive) approach and the Granger non-causality model covering data period 2002Q3-2020Q4. The primary results support a significant long-run relationship between variables, while the results of the MVAR model indicate the per capita cost of war, per capita GDP, and age dependency ratio have significantly positive impacts on per capita health expenditures, whereas child mortality rate and crude death rate have negative impacts. The results of the Granger non-causality approach demonstrate that there is a statistically significant bidirectional causality nexus between per capita health expenditure, per capita cost of war, per capita GDP, child mortality rate, crude death rate, and age dependency ratio, while it also supports the existence of strong and significant interconnectivity and multidimensionality between per capita cost of war and per capita health expenditure, with a significantly strong feedback response from the control variables. Important policy implications sourced from the key findings are also discussed.
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Affiliation(s)
- Mohammad Ajmal Hameed
- School of Business; Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia.
| | - Mohammad Mafizur Rahman
- School of Business; Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
| | - Rasheda Khanam
- School of Business; Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
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Germossa GN, Wondie T, Gerbaba M, Mohammed E, Alemayehu WA, Tekeste A, Mdluli EA, Kenyon T, Collison D, Tsegaye S, Abera Y, Tadesse D, Daga WB, Shaweno T, Abrar M, Ibrahim A, Belete M, Esmael S, Tadesse D, Alemayehu YK, Medhin G, Fayssa MD. Availability of comprehensive emergency obstetric and neonatal care in developing regions in Ethiopia: lessons learned from the USAID transform health activity. BMC Health Serv Res 2022; 22:1307. [PMID: 36324131 PMCID: PMC9628556 DOI: 10.1186/s12913-022-08712-w] [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: 05/16/2022] [Accepted: 10/20/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In collaboration with its partners, the Ethiopian government has been implementing standard Emergency Obstetric and Neonatal Care Services (CEmONC) since 2010. However, limited studies documented the lessons learned from such programs on the availability of CEmONC signal functions. This study investigated the availability of CEmONC signal functions and described lessons learned from Transform Health support in Developing Regional State in Ethiopia. METHOD At baseline, we conducted a cross-sectional study covering 15 public hospitals in four developing regions of Ethiopia (Somali, Afar, Beneshangul Gumz, and Gambella). Then, clinical mentorship was introduced in ten selected hospitals. This was followed by reviewing the clinical mentorship program report implemented in all regions. We used the tool adapted from an Averting Maternal Death and Disability tools to collect data through face-to-face interviews. We also reviewed maternal and neonatal records. We then descriptively analyzed the data and presented the findings using text, tables, and graphs. RESULT At baseline, six out of the 15 hospitals performed all the nine CEmONC signal functions, and one-third of the signal functions were performed in all hospitals. Cesarean Section service was available in eleven hospitals, while blood transfusion was available in ten hospitals. The least performed signal functions were blood transfusion, Cesarean Section, manual removal of placenta, removal of retained product of conceptus, and parenteral anticonvulsants. After implementing the clinical mentorship program, all CEmONC signal functions were available in all hospitals selected for the mentorship program except for Abala Hospital; the number of Cesarean Sections increased by 7.25% at the last quarter of 2021compared to the third quarter of 20,219; and the number of women referred for blood transfusions and further management of obstetric complications decreased by 96.67% at the last quarter of 2021 compared to the third quarter of 20,219. However, the number of women with post-cesarean Section surgical site infection, obstetric complications, facility maternal deaths, neonatal deaths, and stillbirths have not been changed. CONCLUSION The availability of CEmONC signal functions in the supported hospitals did not change the occurrence of maternal death and stillbirth. This indicates the need for investigating underlying and proximal factors that contributed to maternal death and stillbirth in the Developing Regional State of Ethiopia. In addition, there is also the need to assess the quality of the CEmONC services in the supported hospitals, institutionalize reviews, surveillance, and response mechanism for maternal and perinatal or neonatal deaths and near misses.
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Affiliation(s)
- Gugsa Nemera Germossa
- grid.411903.e0000 0001 2034 9160School of Nursing, Jimma University, Jimma, Ethiopia
| | - Tamiru Wondie
- Project HOPE, USAID Transform Health in Developing Regions, Addis Ababa, Ethiopia
| | - Mulusew Gerbaba
- grid.411903.e0000 0001 2034 9160Department of Epidemiology, Jimma University, Jimma, Ethiopia
| | - Eyob Mohammed
- Ethiopian Society of Obstetrics and Gynecology, Addis Ababa, Ethiopia
| | | | - Asayehegn Tekeste
- Project HOPE, USAID Transform Health in Developing Regions, Addis Ababa, Ethiopia
| | - Eden Ahmed Mdluli
- grid.420171.10000 0001 1013 6487Project HOPE, Washington DC, Washington USA
| | - Thomas Kenyon
- grid.420171.10000 0001 1013 6487Project HOPE, Washington DC, Washington USA
| | - Deborah Collison
- grid.420171.10000 0001 1013 6487Project HOPE, Washington DC, Washington USA
| | - Sentayehu Tsegaye
- USAID Transform Health in Developing Regions, Amref Health Africa, Addis Ababa, Ethiopia
| | - Yared Abera
- USAID Transform Health in Developing Regions, Amref Health Africa, Addis Ababa, Ethiopia
| | - Derebe Tadesse
- USAID Transform Health in Developing Regions, Amref Health Africa, Addis Ababa, Ethiopia
| | - Wakgari Binu Daga
- grid.494633.f0000 0004 4901 9060School of Public Health, Wolaita Sodo University, Sodo, Ethiopia
| | - Tamrat Shaweno
- grid.508167.dAfrica Centers for Diseases Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Mohammed Abrar
- Amref Health Africa, Afar Regional Office, Semera, Ethiopia
| | - Ahmed Ibrahim
- AMref Health Africa, Somali Regional Office, Jijiga, Ethiopia
| | - Mebrie Belete
- AMref Health Africa, Gambela Regional Office, Gambela, Ethiopia
| | - Salah Esmael
- Amref Health Africa, Beneshangul Regional Office, Asosa, Ethiopia
| | | | - Yibeltal Kiflie Alemayehu
- MERQ Consultancy PLC, Addis Ababa, Ethiopia ,grid.411903.e0000 0001 2034 9160Department of Health Economics, Management, and Policy, Jimma University, Jimma, Ethiopia
| | - Girmay Medhin
- MERQ Consultancy PLC, Addis Ababa, Ethiopia ,grid.7123.70000 0001 1250 5688Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekdes Daba Fayssa
- Ethiopian Society of Obstetrics and Gynecology, Addis Ababa, Ethiopia ,grid.460724.30000 0004 5373 1026St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Radó MK, van Lenthe FJ, Laverty AA, Filippidis FT, Millett C, Sheikh A, Been JV. Effect of comprehensive smoke-free legislation on neonatal mortality and infant mortality across 106 middle-income countries: a synthetic control study. THE LANCET PUBLIC HEALTH 2022; 7:e616-e625. [DOI: 10.1016/s2468-2667(22)00112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022] Open
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22
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Raru TB, Ayana GM, Yuya M, Merga BT, Kure MA, Negash B, Birhanu A, Alemu A, Dessie Y, Dheresa M. Magnitude, Trends, and Determinants of Institutional Delivery Among Reproductive Age Women in Kersa Health and Demographic Surveillance System Site, Eastern Ethiopia: A Multilevel Analysis. Front Glob Womens Health 2022; 3:821858. [PMID: 35295677 PMCID: PMC8918653 DOI: 10.3389/fgwh.2022.821858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Institutional delivery service utilization is a critical and proven intervention for reducing maternal and neonatal mortality. Institutional delivery service utilization can improve maternal health and wellbeing by ensuring safe delivery and reducing problems occurring during childbirth. In Ethiopia, almost all previous researches were cross-sectional studies and most of them were based on small sample sizes and there are no sufficient reports for the trends. Therefore, this study aimed to assess the magnitude, trends, and determinants of institutional delivery using surveillance data from the Kersa Health and Demographic Surveillance System (HDSS), in Eastern Ethiopia from 2015 to 2020. Methods The study was conducted among reproductive-aged women selected from the Kersa HDSS site, Eastern Ethiopia for the duration of 2015 to 2020. Data were extracted from the Kersa HDSS database system. After coding and recoding, the data was exported to R software for further analysis. A chi-squared test was used for trends to examine the significance of the change. A multilevel logistic regression model was fitted to identify determinants of institutional delivery. An adjusted odds ratio with a 95% confidence interval (CI) was used to measure the strength of the associations. Statistical significance was declared at a p-value < 0.05. Results A total of 20,033 reproductive age women were employed for analysis. The overall magnitude of institutional delivery was 45.03% with 95% CI (44.33–45.72). The institutional delivery has shown a decreasing trend over the 6 years' and there is statistical significance for the declining. Semi-urban resident [AOR = 2.33, 95% CI: 1.37–4.48], urban resident [AOR = 7.18, 95% CI: 5.24, 8.71], read and write [AOR = 1.54, 95% CI: 1.18, 2.01], literate [AOR = 1.46, 95% CI: 1.34–1.59], and antenatal care [AOR = 1.73, 95% CI: 1.58–1.88] were significantly associated with institutional delivery. Conclusion The magnitude of institutional delivery was relatively low and has shown a decreasing trend. Community-based interventions should be strengthened to reverse the decreasing trend of institutional delivery. Targeted information dissemination and communication should be provided to those mothers who have no formal education and attention should be given to rural residents.
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Affiliation(s)
- Temam Beshir Raru
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Galana Mamo Ayana
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mohammed Yuya
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bedasa Taye Merga
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mohammed Abdurke Kure
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- *Correspondence: Mohammed Abdurke Kure
| | - Belay Negash
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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