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Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival
INTRODUCTION: Conflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, ma...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042600/ https://www.ncbi.nlm.nih.gov/pubmed/32133179 http://dx.doi.org/10.1136/bmjgh-2019-002214 |
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author | Akseer, Nadia Wright, James Tasic, Hana Everett, Karl Scudder, Elaine Amsalu, Ribka Boerma, Ties Bendavid, Eran Kamali, Mahdis Barros, Aluisio J D da Silva, Inácio Crochemore Mohnsam Bhutta, Zulfiqar Ahmed |
author_facet | Akseer, Nadia Wright, James Tasic, Hana Everett, Karl Scudder, Elaine Amsalu, Ribka Boerma, Ties Bendavid, Eran Kamali, Mahdis Barros, Aluisio J D da Silva, Inácio Crochemore Mohnsam Bhutta, Zulfiqar Ahmed |
author_sort | Akseer, Nadia |
collection | PubMed |
description | INTRODUCTION: Conflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, maternal, newborn and child health interventions between conflict and non-conflict low-income and middle-income countries (LMICs). METHODS: We carried out a time-series multicountry ecological study using data for 137 LMICs between 1990 and 2017, as defined by the 2019 World Bank classification. The data set covers approximately 3.8 million surveyed mothers (15–49 years) and 1.1 million children under 5 years including newborns (<1 month), young children (1–59 months) and school-aged children and adolescents (5–14 years). Outcomes include annual maternal and child mortality rates and coverage (%) of family planning services, 1+antenatal care visit, skilled attendant at birth (SBA), exclusive breast feeding (0–5 months), early initiation of breast feeding (within 1 hour), neonatal protection against tetanus, newborn postnatal care within 2 days, 3 doses of diphtheria, pertussis and tetanus vaccine, measles vaccination, and careseeking for pneumonia and diarrhoea. RESULTS: Conflict countries had consistently higher maternal and child mortality rates than non-conflict countries since 1990 and these gaps persist despite rates continually declining for both groups. Access to essential reproductive and maternal health services for poorer, less educated and rural-based families was several folds worse in conflict versus non-conflict countries. CONCLUSIONS: Inequalities in coverage of reproductive/maternal health and child vaccine interventions are significantly worse in conflict-affected countries. Efforts to protect maternal and child health interventions in conflict settings should target the most disadvantaged families including the poorest, least educated and those living in rural areas. |
format | Online Article Text |
id | pubmed-7042600 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-70426002020-03-04 Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival Akseer, Nadia Wright, James Tasic, Hana Everett, Karl Scudder, Elaine Amsalu, Ribka Boerma, Ties Bendavid, Eran Kamali, Mahdis Barros, Aluisio J D da Silva, Inácio Crochemore Mohnsam Bhutta, Zulfiqar Ahmed BMJ Glob Health Original Research INTRODUCTION: Conflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, maternal, newborn and child health interventions between conflict and non-conflict low-income and middle-income countries (LMICs). METHODS: We carried out a time-series multicountry ecological study using data for 137 LMICs between 1990 and 2017, as defined by the 2019 World Bank classification. The data set covers approximately 3.8 million surveyed mothers (15–49 years) and 1.1 million children under 5 years including newborns (<1 month), young children (1–59 months) and school-aged children and adolescents (5–14 years). Outcomes include annual maternal and child mortality rates and coverage (%) of family planning services, 1+antenatal care visit, skilled attendant at birth (SBA), exclusive breast feeding (0–5 months), early initiation of breast feeding (within 1 hour), neonatal protection against tetanus, newborn postnatal care within 2 days, 3 doses of diphtheria, pertussis and tetanus vaccine, measles vaccination, and careseeking for pneumonia and diarrhoea. RESULTS: Conflict countries had consistently higher maternal and child mortality rates than non-conflict countries since 1990 and these gaps persist despite rates continually declining for both groups. Access to essential reproductive and maternal health services for poorer, less educated and rural-based families was several folds worse in conflict versus non-conflict countries. CONCLUSIONS: Inequalities in coverage of reproductive/maternal health and child vaccine interventions are significantly worse in conflict-affected countries. Efforts to protect maternal and child health interventions in conflict settings should target the most disadvantaged families including the poorest, least educated and those living in rural areas. BMJ Publishing Group 2020-01-26 /pmc/articles/PMC7042600/ /pubmed/32133179 http://dx.doi.org/10.1136/bmjgh-2019-002214 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Research Akseer, Nadia Wright, James Tasic, Hana Everett, Karl Scudder, Elaine Amsalu, Ribka Boerma, Ties Bendavid, Eran Kamali, Mahdis Barros, Aluisio J D da Silva, Inácio Crochemore Mohnsam Bhutta, Zulfiqar Ahmed Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival |
title | Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival |
title_full | Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival |
title_fullStr | Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival |
title_full_unstemmed | Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival |
title_short | Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival |
title_sort | women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042600/ https://www.ncbi.nlm.nih.gov/pubmed/32133179 http://dx.doi.org/10.1136/bmjgh-2019-002214 |
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