Associations Between Acute Conflict and Maternal Care Usage in Egypt: An Uncontrolled Before-and-After Study Using Demographic and Health Survey Data

Gopalan, Saji Saraswathy; Silverwood, Richard; Salman, Omar; Howard, Natasha

doi:10.15171/ijhpm.2018.107

Cited by 12 publications

(9 citation statements)

References 40 publications

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“…Much of the failure to achieve the health goals set by the World Health Organization in third world countries is attributed to different kinds of crises. During a political or health crisis, women are less likely to seek health care [ 14 , 15 ]. In 2003 in Hong Kong following the SARS epidemic, 75 % of the population reported that they refrained from medical examination due to fear of infection [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Increase rate of ruptured tubal ectopic pregnancy during the COVID-19 pandemic

Dvash

Cuckle

Smorgick

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective During the 2020 COVID-19 pandemic there was a decrease in emergency room arrivals. There is limited evidence about the effect of this change in behavior on women's health. We aimed to evaluate the impact of the COVID-19 pandemic on the diagnosis, treatment and complications of women presenting with a tubal Ectopic Pregnancy (EP). Study design This is a single centre retrospective cohort study. We compared the clinical presentation, treatment modalities and complications of all women presenting in our institution with a tubal EP during the COVID-19 pandemic between 15 March and 15 June 2020, with women who were treated in our institution with the same diagnosis in the corresponding period for the years 2018–2019. Results The study group included 19 cases of EP (N = 19) that were treated between the 15 March 2020 and 15 June 2020. The control group included 30 cases of EP (N = 30) that were admitted to in the corresponding period during 2018 and 2019. Maternal age, parity, gravity and mode of conception (natural vs. assisted) were similar between the two groups. There was no difference in the mean gestational age (GA) according to the last menstrual period. In the study group more women presented with sonographic evaluation of high fluid volume in the abdomen than in the control group (53 % vs 17 %, P value 0.01). This finding is correlated with a more advanced disease status. In the study group there was a highly statistically significant 3-fold increase in rupture among cases ( P < 0.005) and a 4-fold larger volume of blood in the entrance to the abdomen ( P < 0.002). We found that there were no cases of ruptured EP in the group of women who were pregnant after assisted reproduction. Conclusion We found a higher rate of ruptured ectopic pregnancies in our institution during the COVID-19 pandemic. Health care providers should be alerted to this collateral damage in the non-infected population during the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Increase rate of ruptured tubal ectopic pregnancy during the COVID-19 pandemic

Dvash

Cuckle

Smorgick

et al. 2021

European Journal of Obstetrics & Gynecology and Reproductiv

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“…In particular, conflict-affected low- and middle-income countries (LMICs) have been associated with poorer maternal and child health (MCH) outcomes [ 3 ]. It was reported that out of the 34 LMICs furthest from achieving global MCH targets, 22 were identified as conflict-stricken countries [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Effects of Conflicts and Self-Reported Insecurity on Maternal Healthcare Utilisation and Children Health Outcomes in the Democratic Republic of Congo (DRC)

Zhang

et al. 2021

Healthcare

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Background The Democratic Republic of Congo (DRC) has experienced political unrest, civil insecurity, and military disputes, resulting in extreme poverty and a severely impaired health care system. To reduce the morbidity and mortality in women and children by strengthening healthcare, this study aimed at exploring the relationship between self-reported insecurity of mothers and maternal health-seeking behaviours and diseases in children in the DRC. Method Data collected from 8144 mothers and 14,403 children from the Multiple Indicators Cluster Survey (MICS) conducted by the National Institute of Statistics in 2017–2018, in collaboration with the United Nations Children’s Fund (UNICEF), was used. The severity of the conflict in different provinces was measured using the Uppsala Conflict Data Program (UCDP) reports. Multivariate logistic regression and stratified analysis were utilized to explore the association between conflicts with maternal health-seeking behaviours and diseases among children. Results High self-reported insecurity was positively associated with skilled antenatal care (OR1.93, 95%CI 1.50–2.49), skilled attendants at delivery (OR1.42, 95%CI 1.08–1.87), and early initiation of breastfeeding (OR1.32, 95%CI 1.04–1.68). These associations were more significant in regions with more armed conflict. It was also found that children of mothers with high self-reported insecurity were more likely to suffer from diarrhoea (OR1.47, 95%CI: 1.14–1.88), fever (OR1.23, 95%CI 1.01–1.50), cough (OR1.45, 95%CI 1.19–1.77), and dyspnea (OR2.04, 95%CI 1.52–2.73), than children of mothers with low self-reported insecurity. Conclusions Conflicts increases mothers’ insecurities and negatively affects children’s development. However, high conflict regions have to increase governmental and international assistance to promote the availability and access to maternal and child health services.

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“…22 Conversely, other sources have shown limited associations between conflict and maternal health indicators, such as antenatal care and institutional deliveries. 23,24 Further research is needed to document the mechanisms through which conflict influences mortality in C-sections. 25 A previous study reported that the barriers to accessing health care in Afghanistan were associated with a higher number of maternal deaths compared with women who died from non-maternal causes.…”

Section: Discussionmentioning

confidence: 99%

Does the presence of conflict affect maternal and neonatal mortality during Caesarean sections?

Cuesta

Trelles

Naseer³

et al. 2019

public health action

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Introduction: Conflicts frequently occur in countries with high maternal and neonatal mortality and can aggravate difficulties accessing emergency care. No literature is available on whether the presence of conflict influences the outcomes of mothers and neonates during Caesarean sections (C-sections) in high-mortality settings.Objective: To determine whether the presence of conflict was associated with changes in maternal and neonatal mortality during C-sections.Methods: We analysed routinely collected data on C-sections from 17 Médecins Sans Frontières (MSF) health facilities in 12 countries. Exposure variables included presence and intensity of conflict, type of health facility and other types of access to emergency care.Results: During 2008–2015, 30,921 C-sections were performed in MSF facilities; of which 55.4% were in areas of conflict. No differences were observed in maternal mortality in conflict settings (0.1%) vs. non-conflict settings (0.1%) (P = 0.08), nor in neonatal mortality between conflict (12.2%) and non-conflict settings (11.5%) (P = 0.1). Among the C-sections carried out in conflict settings, neonatal mortality was slightly higher in war zones compared to areas of minor conflict (P = 0.02); there was no difference in maternal mortality (P = 0.38).Conclusions: Maternal and neonatal mortality did not appear to be affected by the presence of conflict in a large number of MSF facilities. This finding should encourage humanitarian organisations to support C-sections in conflict settings to ensure access to quality maternity care.

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Associations Between Acute Conflict and Maternal Care Usage in Egypt: An Uncontrolled Before-and-After Study Using Demographic and Health Survey Data

Cited by 12 publications

References 40 publications

Increase rate of ruptured tubal ectopic pregnancy during the COVID-19 pandemic

Increase rate of ruptured tubal ectopic pregnancy during the COVID-19 pandemic

The Effects of Conflicts and Self-Reported Insecurity on Maternal Healthcare Utilisation and Children Health Outcomes in the Democratic Republic of Congo (DRC)

Does the presence of conflict affect maternal and neonatal mortality during Caesarean sections?

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