Impact of conflict on maternal and child health service delivery: a country case study of Afghanistan

Mirzazada, Shafiq; Padhani, Zahra Ali; Jabeen, Sultana; Fatima, Malika; Rizvi, Arjumand; Ansari, Uzair; Das, Jai K; Bhutta, Zulfiqar A

doi:10.1186/s13031-020-00285-x

Cited by 42 publications

(50 citation statements)

References 13 publications

(16 reference statements)

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“…This is consistent with the impact of conflict on maternal and child health services delivery. 19 Countries with poor cohesion often face traditional security threats, such as political violence and armed resistance. The burden has been prevented by diverting extra attention and resources toward medical infrastructure.…”

Section: Discussionmentioning

confidence: 99%

State fragility and the coronavirus disease 2019 (COVID-19) pandemic: an ecologic analysis of data from 146 countries

Duan¹,

Ma²,

Huang³

et al. 2021

Global Health Journal

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Background : Global spread and impact of the coronavirus disease 2019 (COVID-19) pandemic are determined to a large extent, by resistance to the pandemic and public response of all countries in the world; while a country's resistance and response are in turn determined by its political and socio economic conditions. To inform future disease prevention and control, we analyzed global data to exam the relationship between state vulnerabilities and COVID-19 incidences and deaths. Methods : Vulnerability was measured using the Fragile States Index (FSI). FSI is created by the Fund for Peace to assess levels of fragility for individual countries. Total FSI score and scores for 12 specific indicators were used as the predictor variables. Outcome variables were national cumulative COVID-19 cases and deaths up to September 16, 2020, derived the World Health Organization. Cumulative incidence rates were computed using 2019 National population derived from the World Bank, and case fatality rates were computed as the ratio of deaths/COVID-19 cases. Countries with incomplete data were excluded, yielding a final sample of 146 countries. Multivariate regression was used to examine the association between the predictor and the outcome measures. Results : There were dramatic cross-country variations in both FSI and COVID-19 epidemiological measurements. FSI total scores were negatively associated with both COVID-19 cumulative incidence rates (β = -0.0135, P < 0.001) and case fatality rates (β = -0.0147, P < 0.05). Of the 12 FSI indicators, three negatively associated with COVID-19 incidences were E1(Economic Decline and Poverty), E3 (Human Flight and Brain Drain), and S2 (Refugees and Internally Displaced Persons); two positively associated were P1 (State Legitimacy) and X1 (External Intervention). With regard to association with case fatality rates, C1 (Security Apparatus) was positive, and P3 (Human Rights and Rule of Law) and X1 was negative. Conclusions : With FSI measures by the Fund of Peace, overall, more fragile countries are less likely to be affected by the COVID-19 pandemic, and even if affected, death rates were lower. However, poor in state legitimacy and lack of external intervention are risk for COVID-19 infection and lack of security apparatus is risky for COVID-19 death. Implications of the study findings are discussed and additional studies are needed to examine the mechanisms underpinning these relationships.

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Section: Discussionmentioning

confidence: 99%

State fragility and the coronavirus disease 2019 (COVID-19) pandemic: an ecologic analysis of data from 146 countries

Duan¹,

Ma²,

Huang³

et al. 2021

Global Health Journal

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“…In Afghanistan and Pakistan, our analysis suggested a statistically significant difference in coverage of various WCH interventions between severely/moderately and minimally conflict-affected provinces/districts based on the battle-related deaths. 16,17 In Colombia, maternal mortality, antenatal care coverage, caesarean section rate, and fertility in 15 to 19 year-old adolescents were significantly different in municipalities with high versus low levels of conflict (measured as victimisation rates), and no statistically significant difference was found in vaccination coverage, neonatal, early neonatal and infant mortality rates between high and low conflict quintiles. 18 In Nigeria, although there were differences in various indicators including vaccination coverage and neonatal and child mortality among the conflict-affected, marginal and stable (non-conflict) areas, these differences were not statistically significant.…”

Section: Panel 1 Case Study Selection Criteria and Methodologymentioning

confidence: 98%

“…18,20,21,28 For respondents in Syria and Afghanistan, such negotiations with opposition parties allowed access to restricted geographies during a a polio campaign. 16,26…”

Section: Rebuilding Trust In the Communitymentioning

confidence: 99%

Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies?

et al. 2021

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Armed conflict disproportionately affects women, newborns, children, and adolescents. Our study presents insights from a collection of ten country case studies aiming to assess the provision of sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (abbreviated to women's and childern's health, i.e WCH in this paper) interventions in conflict-affected settings in Afghanistan,

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“…Detailed reports of the BRANCH case studies [13][14][15][16][17][18][19][20][21][22] as well as a cross-case synthesis of findings [23] are published elsewhere. For this additional paper, we aimed to highlight and discuss some of the research challenges faced and the corresponding mitigation strategies used by the international research teams conducting BRANCH case studies in Somalia, Mali, Pakistan and Afghanistan ( Table 1).…”

Section: Research Studiesmentioning

confidence: 99%

“…In the Afghanistan and Pakistan case studies, additional analyses investigated trends in intervention coverage stratified by conflict intensity. The research teams used a novel Delphi approach to classify the intensity of conflict in each province in Afghanistan and in each district or agency in Balochistan or FATA in Pakistan by soliciting consensus opinion from a panel of experts in each country on the extent to which access to and provision of health services was affected by armed conflict in each area [17,18]. This approach supplemented an assessment of conflict intensity based on the number of direct deaths resulting from conflict events in a given time and space ("battle-related deaths"), based on data from the widely used and publicly available database compiled by the Uppsala Conflict Data Program [33].…”

Section: Lack Of Reliable Intervention Coverage and Other Quantitativmentioning

confidence: 99%

Researching the delivery of health and nutrition interventions for women and children in the context of armed conflict: lessons on research challenges and strategies from BRANCH Consortium case studies of Somalia, Mali, Pakistan and Afghanistan

et al. 2020

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Background The BRANCH Consortium recently conducted 10 mixed-methods case studies to investigate the provision of health and nutrition interventions for women and children in conflict-affected countries, aiming to better understand the dominant influences on humanitarian health actors’ programmatic decision-making and how such actors surmount intervention delivery barriers. In this paper, the research challenges encountered and the mitigating strategies employed by the case study investigators in four of the BRANCH case study contexts are discussed: Somalia, Mali, Pakistan and Afghanistan. Discussion Many of the encountered research challenges were anticipated, with investigators adopting mitigation strategies in advance or early on, but others were unexpected, with implications for how studies were ultimately conducted and how well the original study aims were met. Insecurity was a fundamental challenge in all study contexts, with restricted geographical access and concerns for personal safety affecting sampling and data collection plans, and requiring reliance on digital communications, remote study management, and off-site team meetings wherever possible. The need to navigate complex local sociopolitical contexts required maximum reliance on local partners’ knowledge, expertise and networks, and this was facilitated by early engagement with a wide range of local study stakeholders. Severe lack of reliable quantitative data on intervention coverage affected the extent to which information from different sources could be triangulated or integrated to inform an understanding of the influences on humanitarian actors’ decision-making. Conclusion Strong local partners are essential to the success of any project, contributing not only technical and methodological capacity but also the insight needed to truly understand and interpret local dynamics for the wider study team and to navigate those dynamics to ensure study rigour and relevance. Maintaining realistic expectations of data that are typically available in conflict settings is also essential, while pushing for more resources and further methodological innovation to improve data collection in such settings. Finally, successful health research in the complex, dynamic and unpredictable contexts of conflict settings requires flexibility and adaptability of researchers, as well as sponsors and donors.

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Impact of conflict on maternal and child health service delivery: a country case study of Afghanistan

Cited by 42 publications

References 13 publications

State fragility and the coronavirus disease 2019 (COVID-19) pandemic: an ecologic analysis of data from 146 countries

State fragility and the coronavirus disease 2019 (COVID-19) pandemic: an ecologic analysis of data from 146 countries

Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies?

Researching the delivery of health and nutrition interventions for women and children in the context of armed conflict: lessons on research challenges and strategies from BRANCH Consortium case studies of Somalia, Mali, Pakistan and Afghanistan

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