Armed Conflicts and National Trends in Reproductive, Maternal, Newborn and Child Health in Sub-Saharan Africa: What Can National Health Surveys Tell Us?

Abstract

Background: Armed conflicts are widespread in sub-Saharan Africa and considered to be an important factor in slowing down national progress in reproductive, maternal, newborn and child health (RMNCH). Methods: Among Sub-Saharan countries that had experienced major conflicts, 13 countries were selected based on battle-related deaths and national survey data availability. National levels and trends in RMNCH intervention coverage, wasting and stunting in children under 5 years of age and under-five mortality were analysed in related to the timing of the conflict and compared to sub-regional trends during 1990-2016. Results: The 13 countries conducted 53 DHS or MICS surveys since 1986. Most surveys did not report major sampling or implementation problems. In comparison to the regional averages for either West and Central Africa or Eastern and Southern Africa, conflict-affected countries generally had lower coverage of RMNCH interventions during the conflict phase or immediately post-conflict, and often experienced rapid coverage improvements following the end of the conflict. Levels and trends in wasting, but not stunting, and under-five mortality followed a similar pattern with higher levels and/or slower declines during the conflicts and a recovery post-conflict in most countries. In several countries, however, the levels and trends in surveys showed only limited or no effect of a conflict on one or more indicators of national coverage, child growth or mortality. Interpretation: National surveys provide a useful source of data for the measurement of the longer-term national impact of conflicts on RMNCH intervention coverage, child growth and under-five mortality. The results vary considerably between countries, requiring more in-depth analysis of surveys and other data to estimate the full impact of conflicts as well as improved data collection. Funding: This work was supported by a grant of the Bill and Melinda Gates Foundation to the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health. Declaration of Interest: We have no conflict of interest. Ethical Approval: This paper was exempted from obtaining ethical approval since it was entirely based on data available in the public domain.