Please use this identifier to cite or link to this item: https://doi.org/10.15171/ijhpm.2018.107
Title: Associations Between Acute Conflict and Maternal Care Usage in Egypt: An Uncontrolled Before-and-After Study Using Demographic and Health Survey Data
Authors: Gopalan, Saji S
Silverwood, Richard J
Salman, Omar
Howard, Natasha 
Keywords: Acute Conflict
Maternal Care
Multi-Level Modelling
Egypt
Issue Date: 1-Mar-2019
Publisher: KERMAN UNIV MEDICAL SCIENCES
Citation: Gopalan, Saji S, Silverwood, Richard J, Salman, Omar, Howard, Natasha (2019-03-01). 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) : 158-167. ScholarBank@NUS Repository. https://doi.org/10.15171/ijhpm.2018.107
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.
Source Title: INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT
URI: https://scholarbank.nus.edu.sg/handle/10635/205335
ISSN: 23225939
DOI: 10.15171/ijhpm.2018.107
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