Background: In conflict-afflicted areas, pregnant women and newborns often have higher rates of adverse health outcomes. Objective: To describe maternal and child health indicators and interventions between 1998 and 2016 comparing high and low conflict areas in Colombia. Methods: Mixed study of convergent triangulation. In the quantitative component, 16 indicators were calculated using official, secondary data sources. The victimization rate resulting from armed conflict was calculated by municipality and grouped into quintiles. In the qualitative component, a comparative case study was carried out in two municipalities of Antioquia: one with high rates of armed conflict and another with low rates. A total of 41 interviews and 8 focus groups were held with local and national government officials, health professionals, community informants, UN agencies and NGOs. Results: All of the indicators show improvement, however, four show statistically significant differences between municipalities with high victimization rates versus low ones. The maternal mortality ratio was higher in the municipalities with greater victimization in the periods 1998-2004, 2005-2011 and 2012-2016. The percentage of cesarean births and women who received four or more antenatal visits was lower among women who experienced the highest levels of victimization for the period 1998-2000, while the fertility rate for women between 15 and 19 years was higher in these municipalities between 2012 and 2016. In the context of the armed conflict in Colombia, maternal and child health was affected by the limited availability of interventions given the lack of human resources in health, supplies, geographical access difficulties and insecurity. The national government was the one that mostly provided the programs, with difficulties in continuity and quality. UN Agencies and NGOs accessed more easily remote and intense armed conflict areas. Few specific health interventions were identified in the postconflict context. Conclusions: In Colombia, maternal and child health indicators have improved since the conflict, however a pattern of inequality is observed in the municipalities most affected by the armed conflict.
Objetivo: describir la mortalidad perinatal del departamento de Antioquia según la Clasificación Internacional de Enfermedades CIE-MP de la Organización Mundial de la Salud (OMS) y evaluar la factibilidad de aplicar el sistema de clasificación a partir los registros vitales oficiales. Materiales y métodos: estudio descriptivo de las causas de muerte perinatal según el momento del fallecimiento con respecto al parto y las condiciones maternas asociadas. La fuente primaria fue la base de datos oficial de estadísticas vitales entre los años 2013 y 2016. Se midieron: la edad materna, la edad gestacional, el peso al momento del parto, el área de residencia, el tipo de parto, las causas de muerte (directas, asociadas) y otros estados patológicos. Se hace análisis descriptivo, se presenta el número absoluto y el porcentaje de las causas distribuidas según el momento de ocurrencia de la muerte con respecto al parto y el peso al nacer. Resultados: de 3901 muertes perinatales ocurridas en fetos con 22 semanas o más, o mínimo 500 g de peso y hasta los 28 días de vida, 1404 (36,0 %) se presentaron antes del parto, 378 (9,7 %) en el intraparto, 1760 (45,1 %) en el periodo neonatal y 359 (9,2 %) casos no contaban con información del momento del fallecimiento con relación al parto. Las principales causas de muerte de los recién nacidos de 1000 o más g fueron las malformaciones congénitas, las deformidades y las anormalidades cromosómicas (30,2 %); la hipoxia anteparto e intraparto (29,3 %) y la infección (12,3 %). En el 69,5 % no se identificaron causas maternas asociadas, y en las identificadas, la más frecuente fue la complicación de placenta, cordón y membranas (16,8 %). Conclusión: el CIE-MP es un sistema de clasificación aplicable globalmente a partir de los registros vitales, que permitió caracterizar la mortalidad perinatal del departamento.
Background Colombia has been affected by internal armed conflict for 70 years. About 7.3 million people have been internally displaced and nearly 50% of them were women. In conflict-afflicted areas, pregnant women and newborns have higher rates of adverse health outcomes. Methods Secondary analysis of public databases. We examined sixteen indicators from the Countdown to 2030 initiative, for which data from Colombia were available and reliable between 1998 and 2016. We also constructed a variable (victimization rate) to measure the intensity of the conflict for each municipality/year and grouped them into quintiles. We compared relative differences and confidence intervals using the Rothman and Greenland method. Results Across time, most indicators improved in all municipalities. However, four indicators were significantly different between municipalities with high versus low victimization rates. The maternal mortality ratio was higher in the municipalities with higher victimization rates in the periods 1998-2004, 2005-2011 and 2012-2016. The percentages of caesarean births and women who received four or more antenatal care visits were lower in settings with highest levels of victimization (1998-2000,) while the fertility rate among women 15-19 years old was higher in those municipalities between 2012 and 2016. Conclusions In Colombia, several maternal and child health indicators have improved during the years of the conflict; however, municipalities most affected by the armed conflict had poorer reproductive and maternal health outcomes. Key messages Maternal and reproductive health were negatively affected by protracted armed conflict in Colombia.
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