Impacts of Armed Conflict on Maternal and Child Health Care Utilization in Myanmar

Details

Supervisors

Guha-Sapir, Debarati ; Schlüter, Benjamin-Samuel

Faculty

Faculté de santé publique

Degree label

Master [120] en sciences de la santé publique

Abstract

RESUME Background-Armed conflict is a global challenge in public health and annually 740,000 people dies from it. It is a fourth leading cause of global deaths in 15-44 years age group. The consequences of armed violence negatively impact on health system, including Maternal and Child Health (MCH) care utilization. This study explores impact of conflict on MCH care indicators in Myanmar, a Southeast Asian country with decades-long civil wars history. Methods-Datasets from Myanmar Demographic and Health Surveys (MDHS) and Uppsala Conflict Data Program (UCDP) were used. A total of 3700 mothers who gave recent births in 5 years had been included. The georeferenced MDHS cluster location and UCDP conflict points were plotted by QGIS, a professional geospatial software. Logistic Regression was used to estimate the odds of mothers utilizing MCH services based on the explanatory variables of any exposure, duration and frequency of conflict in comparison to non-exposed mothers. Results-Of 3700 mothers ,1453 reside in conflict zone. None of the mothers who experienced conflict in 2015 attended 4 times or higher ANC (AOR= 0.00). Mothers in 2nd quartile of frequency of violent events (3 times exposed to violent events) had lower odds of ANC visits and institutional delivery by 60% (95% CI=0.43-0.81%, p<0.01) and 64 % (CI=0.45-0.93%, p<0.05) respectively. Children from mothers exposed to conflict in 2015 had lower DPT3(3 doses of diptheria-pertusis -tetanus) vaccination by 22% (95%CI=0.08-0.66, p<0.05). Mothers who exposed to any conflict, conflict in 2011-14, 1st and 3rd quartile of frequency of violent events (2 and 8 times exposed to violent events) checked their baby’s post-natal health in 2 months more than non-exposed mothers. Receiving DPT3 vaccination was also found higher in children whose mothers were exposed to any conflict, 2011-14, 2011-15, 1st and 4th quartile of frequency of violent events (2 and 111 times exposed to violent events). Conclusion- Children from mothers exposed to conflict received more postnatal check and DPT3. In terms of conflict duration, DPT3 vaccination was found lower in children whose mothers were exposed to conflicts in 2015. However, children from mothers who experienced conflict 2011-14 had more postnatal checkup and completed DPT3 during 2011-14 and 2011-15. With regards to conflict frequency, mothers affected by 3 violent events had lower ANC attendance and institutional delivery. However, DPT3 vaccination was found higher among children from mothers who faced 2 and 111 times of violent events. Mothers who faced 2 and 8 times of violent events also presented higher postnatal health check for their babies. The positive correlation between conflict and some MCH utilization could be the intervention of humanitarian organizations in the conflict affected regions. Therefore, we can conclude that armed conflict can have a negative impact on MCH utilizations to some extent; however, the effects of sociodemographic characteristics (age, education, residential place, wealth, distance to health facility, occupation, etc.) and external factors (conflict intensity, weakened health system, humanitarian aids, government’s management etc.) should be addressed as it also influences MCH utilization.