Obstetrics during civil war: Six months on a maternity ward in Mallavi, Northern Sri Lanka

Abstract

A long-term, large-scale ethnic armed conflict continues in Sri Lanka, where militant separatists control a northern section of the island. The conflict has resulted in a large population of internally displaced persons and a shortage of medical staff. Drug and equipment shortages compound the difficulty in access to medical care. This article reports the experiences from 1 November 2000 to 30 April 2001 recorded by review of medical records and by interviews, in the peripheral unit, in a separatist controlled area of the Mallavi maternity ward. There were 704 births. Most of the mothers had been displaced by the war (69.5 per cent) and had experienced food shortage (67.5 per cent). Referred patients (18.1 per cent) had a high rate of caesarean section (44.3 per cent) and had travelled a mean of 57.6 km to reach Mallavi. There had been substantial antenatal care (94.0 per cent), tetanus toxoid vaccination (95.1 per cent) and malaria prophylaxis (86.4 per cent). Risk factors for low birth weight included a maternal body mass index less than 19 (RR 1.55, CI 1.11-2.16, P = .011), primiparity (RR 1.44, CI 1.05-1.97, P = .024) and self-reported malarial infection during pregnancy (RR 1.42, CI 1.03-1.97, P = .036). Rates of low birth weight, stillbirths, neonatal deaths and maternal mortality in the Mallavi units were higher than the Sri Lankan national averages. Improvements in quality of care and access to health care are unlikely while the war continues.

Antenatal Care Utilization in a Conflict‐Affected District of Northern Sri Lanka

“…However, almost all mothers had received some ANC at a level comparable to the national situation (Ministry of Health, 2007). These results were supported by the findings of two studies in similar areas-Mallavi (94%) and Kopay (98.2%)within the Northern Province (Simetka et al, 2002;Surenthirakumaran, 2007). Increased attendance to antenatal clinics despite the conflict situation is a favorable indication for ANC utilization; thus, service providers should focus more on quality of care rather than increasing the frequency of visits routinely.…”

Perinatal mortality in non-western migrants in Norway as compared to their countries of birth and to Norwegian women

“…Sri Lankan migrants in Norway are mainly Tamils from the conflict affected regions of Sri Lanka [15]. Rates of stillbirths, neonatal and maternal deaths have been reported to be higher in these regions than in other regions of Sri Lanka [16-18]. We used the PMR for Sri Lanka as a whole in our study.…”

A review and analysis of intensive care medicine in the least developed countries*

“…Whereas trauma patients make up a comparably minor portion of critically ill patients except in military hospitals, there is an abrupt increase in acute cardiac, cerebrovascular, and medical diseases (68). Simetka et al (69) reported on a significant increase in the rates of low birth weight, stillbirths, neonatal deaths, and maternal mortality during civil war in Sri Lanka. Particularly in times of war, occupancy of ICU beds is often paradoxically lower than during peace, since ongoing conflicts, lack of transportation possibilities, high numbers of severely injured civilians, and extreme poverty with lack of financial resources prevent patients from presenting to hospitals or other health care facilities (70,71).…”