Armed conflicts and national trends in reproductive, maternal, newborn and child health in sub-Saharan Africa: what can national health surveys tell us?

Abstract

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). The measurement of the impact of conflicts on national levels and trends in RMNCH is difficult. National surveys conducted before and sometimes during and after conflicts are a major source of information on the national and local effects of conflicts on RMNCH. We examined data from national surveys in 13 countries in sub-Saharan Africa with major conflicts during 1990-2016 to assess the levels and trends in RMNCH intervention coverage, nutritional status and mortality in children under 5 years in comparison with subregional trends. The surveys provide substantive evidence of a negative association between levels and trends in national indicators of RMNCH service coverage, child growth and under-5 mortality with armed conflict, with some notable exceptions. National surveys are an important source of data to assess the longer term national consequences of conflicts for RMNCH in most countries, despite limitations due to sampling and timing of the surveys.

Keywords: Africa; armed conflict; child growth; child mortality; coverage of interventions; household surveys; maternal newborn and child health; reproductive health.

Figure 1

RMNCH CCI in conflict-affected countries based on surveys conducted during the conflict phase, within 5 years postconflict and 5–9 years postconflict: absolute difference of each country CCI and subregional estimates for Eastern and Southern Africa and for West and Central Africa for the survey year. CCI, Composite Coverage Index; RMNCH, reproductive, maternal, newborn and child health.

Figure 2

Stunting (A) and wasting (B) among children under 5 years in conflict-affected countries based on surveys conducted during the conflict phase, within 5 years postconflict and 5–9 years postconflict: absolute difference of each country CCI and subregional estimates for Eastern and Southern Africa and for West and Central Africa for the survey year. CCI, Composite Coverage Index.

Figure 3

Difference of the average annual rate of change (AARC) in under-5 mortality between each conflict-affected country and the subregional trends for Eastern and Southern Africa or West and Central Africa (negative value indicates absolute per cent slower decline than the subregion).