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Associations between acute conflict and maternal care usage in Egypt: An uncontrolled before-and-after study using demographic and health survey data

Gopalan, SS; Silverwood, RJ; Salman, O; Howard, N; (2019) Associations between acute conflict and maternal care usage in Egypt: An uncontrolled before-and-after study using demographic and health survey data. International Journal of Health Policy and Management , 8 (3) , Article 4. 10.15171/ijhpm.2018.107. Green open access

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Abstract

Background: United Nations’ (UN) data indicate that conflict-affected low-and middle-income countries (LMICs) contribute considerably to global maternal deaths. Maternal care usage patterns during conflict have not been rigorously quantitatively examined for policy insights. This study analysed associations between acute conflict and maternal services usage and quality in Egypt using reliable secondary data (as conflict-affected settings generally lack reliable primary data). Methods: An uncontrolled before-and-after study used data from the 2014 Egypt Demographic and Health Survey (EDHS). The ‘pre-conflict sample’ included births occurring from January 2009 to January 2011. The ‘peri-conflict sample’ included births from February 2011 to December 2012. The hierarchical nature of demographic and household survey (DHS) data was addressed using multi-level modelling (MLM). Results: In total, 2569 pre-conflict and 4641 peri-conflict births were reported. After adjusting for socioeconomic variables, conflict did not significantly affect antenatal service usage. Compared to the pre-conflict period, peri-conflict births had slightly lower odds of delivery in public institutions (odds ratio [OR]: 0.987; 95% CI: 0.975-0.998; P < .05), institutional postnatal care (OR: 0.995; 95% CI: 0.98-1.00; P = .05), and at least 24 hours post-delivery stay (OR: 0.921; 95% CI: 0.906-0.935; P < .01). Peri-conflict births had relatively higher odds of doctor-assisted deliveries (OR: 1.021; 95% CI: 1.004-1.035; P < .05), institutional deliveries (OR: 1.022; 95% CI: 1.00-1.04; P < .05), private institutional deliveries (OR: 1.035; 95% CI: 1.017-1.05; P < .001), and doctor-assisted postnatal care (OR: 1.015; 95% CI: 1.003-1.027; P < .05). Sensitivity analysis did not change results significantly. Conclusion: Maternal care showed limited associations with the acute conflict, generally reflecting pre-conflict usage patterns. Further qualitative and quantitative research could identify the effects of larger conflicts on maternal care-seeking and usage, and inform approaches to building health system resilience.

Type: Article
Title: Associations between acute conflict and maternal care usage in Egypt: An uncontrolled before-and-after study using demographic and health survey data
Open access status: An open access version is available from UCL Discovery
DOI: 10.15171/ijhpm.2018.107
Publisher version: https://doi.org/10.15171/IJHPM.2018.107
Language: English
Additional information: Copyright: © 2019 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Acute Conflict, Maternal Care, Multi-Level Modelling, Egypt
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Education
UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education
UCL > Provost and Vice Provost Offices > School of Education > UCL Institute of Education > IOE - Social Research Institute
URI: https://discovery.ucl.ac.uk/id/eprint/10069730
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