Dynamics of socioeconomic risk factors for neglected tropical diseases and malaria in an armed conflict

Abstract

Background: Armed conflict and war are among the leading causes of disability and premature death, and there is a growing share of civilians killed or injured during armed conflicts. A major part of the civilian suffering stems from indirect effects or collateral impact such as changing risk profiles for infectious diseases. We focused on rural communities in the western part of Côte d'Ivoire, where fighting took place during the Ivorian civil war in 2002/2003, and assessed the dynamics of socioeconomic risk factors for neglected tropical diseases (NTDs) and malaria.

Methodology: The same standardized and pre-tested questionnaires were administered to the heads of 182 randomly selected households in 25 villages in the region of Man, western Côte d'Ivoire, shortly before and after the 2002/2003 armed conflict.

Principal findings: There was no difference in crowding as measured by the number of individuals per sleeping room, but the inadequate sanitation infrastructure prior to the conflict further worsened, and the availability and use of protective measures against mosquito bites and accessibility to health care infrastructure deteriorated. Although the direct causal chain between these findings and the conflict are incomplete, partially explained by the very nature of working in conflict areas, the timing and procedures of the survey, other sources and anecdotal evidence point toward a relationship between an increased risk of suffering from NTDs and malaria and armed conflict.

Conclusion: New research is needed to deepen our understanding of the often diffuse and neglected indirect effects of armed conflict and war, which may be worse than the more obvious, direct effects.

Figure 1. Conceptual framework: direct and indirect effects of an armed conflict on health status of households.

Figure 2. Operational result of the two surveys carried out in August 2002 and late 2003/early 2004 in the region of Man, western Côte d'Ivoire, and the final study sample.

Figure 3. Pie chart illustrating the reported causes of death (in % of all deaths).

Figure 4. Quantile-quantile plot of the number of individuals per sleeping room in the two surveys carried out in August 2002 and late 2003/early 2004 in the region of Man, western Côte d'Ivoire.