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

Abstract

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.

Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria

“…Of the 21 included articles, 13 were peer-reviewed studies15–27 and 8 grey literature reports 28–35. Of the 13 peer-reviewed studies, 6 were secondary data analysis,15–19 27 3 were cross-sectional studies,21 25 28 1 clinical audit,23 1 literature review,22 1 case study,24 1 prospective data registry study26 and 1 mixed-method study that included a literature review and country-level data reporting 20. From the grey literature reports, four were country-level data reporting,28–30 35 two were activity reports,33 34 one was secondary data analysis32 and one was a qualitative study 31.…”

“…Twelve studies describe caesarean sections compared with vaginal births 15 21–23 25–27 31–35. Of these, 1115 21–23 25–27 31–33 35 reported facility level, caesarean section rates higher than the population-level WHO recommended 10%–15%, with the remaining study34 reporting no births in its Syrian facilities during the included study period. These studies are summarised in table 2.…”

“…Of the 21 included articles, 13 were peer-reviewed studies [15][16][17][18][19][20][21][22][23][24][25][26][27] and 8 grey literature reports. [28][29][30][31][32][33][34][35] Of the 13 peer-reviewed studies, 6 were secondary data analysis, 15-19 27 3 were cross-sectional studies, 21 25 28 1 clinical audit, 23 1 literature review, 22 1 case study, 24 1 prospective data registry study 26 and 1 mixed-method study that included a literature review and country-level data reporting.…”