IntroductionConflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, maternal, newborn and child health interventions between conflict and non-conflict low-income and middle-income countries (LMICs).MethodsWe carried out a time-series multicountry ecological study using data for 137 LMICs between 1990 and 2017, as defined by the 2019 World Bank classification. The data set covers approximately 3.8 million surveyed mothers (15–49 years) and 1.1 million children under 5 years including newborns (<1 month), young children (1–59 months) and school-aged children and adolescents (5–14 years). Outcomes include annual maternal and child mortality rates and coverage (%) of family planning services, 1+antenatal care visit, skilled attendant at birth (SBA), exclusive breast feeding (0–5 months), early initiation of breast feeding (within 1 hour), neonatal protection against tetanus, newborn postnatal care within 2 days, 3 doses of diphtheria, pertussis and tetanus vaccine, measles vaccination, and careseeking for pneumonia and diarrhoea.ResultsConflict countries had consistently higher maternal and child mortality rates than non-conflict countries since 1990 and these gaps persist despite rates continually declining for both groups. Access to essential reproductive and maternal health services for poorer, less educated and rural-based families was several folds worse in conflict versus non-conflict countries.ConclusionsInequalities in coverage of reproductive/maternal health and child vaccine interventions are significantly worse in conflict-affected countries. Efforts to protect maternal and child health interventions in conflict settings should target the most disadvantaged families including the poorest, least educated and those living in rural areas.

Background Senegal has been an exemplar country in the West African region, reducing child stunting prevalence by 17.9% from 1992 to 2017. Objectives In this study, we aimed to conduct a systematic in-depth assessment of factors at the national, community, household, and individual levels to determine the key enablers of Senegal's success in reducing stunting in children &lt;5 y old between 1992/93 and 2017. Methods A mixed methods approach was implemented, comprising quantitative data analysis, a systematic literature review, creation of a timeline of nutrition-related programs, and qualitative interviews with national and regional stakeholders and mothers in communities. Demographic and Health Surveys and Multiple Indicator Cluster Surveys were used to explore stunting inequalities and factors related to the change in height-for-age z-score (HAZ) using difference-in-difference linear regression and the Oaxaca-Blinder decomposition method. Results Population-wide gains in average child HAZ and stunting prevalence have occurred from 1992/93 to 2017. Stunting prevalence reduction varied by geographical region and prevalence gaps were reduced slightly between wealth quintiles, maternal education groups, and urban compared with rural residence. Statistical determinants of change included improvements in maternal and newborn health (27.8%), economic improvement (19.5%), increases in parental education (14.9%), and better piped water access (8.1%). Key effective nutrition programs used a community-based approach, including the Community Nutrition Program and the Nutrition Enhancement Program. Stakeholders felt sustained political will and multisectoral collaboration along with improvements in poverty, women's education, hygiene practices, and accessibility to health services at the community level reduced the burden of stunting. Conclusions Senegal's success in the stunting decline is largely attributed to the country's political stability, the government's prioritization of nutrition and execution of nutrition efforts using a multisectoral approach, improvements in the availability of health services and maternal education, access to piped water and sanitation facilities, and poverty reduction. Further efforts in the health, water and sanitation, and agriculture sectors will support continued success.

Reprinted) May 12, 2021 1/3the effect of time spent in the pandemic by incorporating an interaction term between our exposure (pandemic vs historical birth) and number of weeks since March 15, 2020, for each PTB outcome.Analyses were performed using SAS Enterprise Guide statistical software version 7.15 (SAS Institute).Statistical tests were 2-sided, with α < .05 considered significant. Data analysis was performed from March 15 to September 30, 2020. ResultsA total of 67 747 births occurred during the pandemic period, and 348 633 births occurred during the historical period. There were no differences in baseline characteristics between groups. There was no difference in the proportion of PTBs (5103 [7.5%] vs 26 216 [7.5%] PTBs) or stillbirths (347 [0.5%] vs 1799 [0.5%] stillbirths) between the pandemic and historical groups. After multivariable analysis, the adjusted odds ratio (aOR) for PTB was 1.00 (95% CI, 0.97-1.03), and that for stillbirth was 0.99 (95% CI, 0.89-1.11) (Table ). We observed a small but significant difference in very PTB (<32 weeks' GA) in the 2 groups (4531 [1.3%] vs 807 [1.2%] very PTBs; OR, 0.89; 95% CI, 0.80-0.99), which persisted after multivariable adjustment (aOR, 0.91; 95% CI, 0.85-0.98). There were no differences in extreme PTB, severe small for GA, neonatal intensive care unit admission, or neonatal death. We found no significant association between time spent in the pandemic and any outcome. DiscussionWe found no differences in the overall risk of PTB, stillbirth, or other perinatal outcomes during the first 6 months of the COVID-19 pandemic. We observed a small reduction in PTB at less than 32 weeks' GA, similar to Denmark and Ireland, where comparable strict lockdown measures were in effect. 1,2 In contrast, no difference in PTB was observed in a population-based study in Sweden, where strict lockdown orders were not in effect. 6Limitations of this study include the inability to evaluate out-of-hospital births; however, less than 3% of births in Ontario occur outside of hospitals. We could not evaluate for some factors that influence PTB risk, such as smoking. We did not evaluate the risk of PTB among women who experienced COVID-19 during pregnancy because this number was small.The COVID-19 pandemic first wave did not coincide with significant changes in overall PTB or stillbirth in Ontario. A small reduction in PTB at less than 32 weeks' GA suggests that strict lockdown measures may have been associated with reduced risk in this subgroup.