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

Background United Nations’ (UN) data indicate that conflict-affected low- and middle-income countries (LMICs) contribute considerably to global maternal deaths. Maternal care usage patterns during conflict have not been rigorously quantitatively examined for policy insights. This study analysed associations between acute conflict and maternal services usage and quality in Egypt using reliable secondary data (as conflict-affected settings generally lack reliable primary data).   Methods An uncontrolled before-and-after study used data from the ۲۰۱۴ Egypt Demographic and Health Survey (EDHS). The ‘pre-conflict sample’ included births occurring from January ۲۰۰۹ to January ۲۰۱۱. The ‘peri-conflict sample’ included births from February ۲۰۱۱ to December ۲۰۱۲. The hierarchical nature of demographic and household survey (DHS) data was addressed using multi-level modelling (MLM).   Results In total, ۲۵۶۹ pre-conflict and ۴۶۴۱ peri-conflict births were reported. After adjusting for socioeconomic variables, conflict did not significantly affect antenatal service usage. Compared to the pre-conflict period, peri-conflict births had slightly lower odds of delivery in public institutions (odds ratio [OR]: ۰.۹۸۷; ۹۵% CI: ۰.۹۷۵-۰.۹۹۸; P < .۰۵), institutional postnatal care (OR: ۰.۹۹۵; ۹۵% CI: ۰.۹۸-۱.۰۰; P = .۰۵), and at least ۲۴ hours post-delivery stay (OR: ۰.۹۲۱; ۹۵% CI: ۰.۹۰۶-۰.۹۳۵; P < .۰۱). Peri-conflict births had relatively higher odds of doctor-assisted deliveries (OR: ۱.۰۲۱; ۹۵% CI: ۱.۰۰۴-۱.۰۳۵; P < .۰۵), institutional deliveries (OR: ۱.۰۲۲; ۹۵% CI: ۱.۰۰-۱.۰۴; P < .۰۵), private institutional deliveries (OR: ۱.۰۳۵; ۹۵% CI: ۱.۰۱۷-۱.۰۵; P < .۰۰۱), and doctor-assisted postnatal care (OR: ۱.۰۱۵; ۹۵% CI: ۱.۰۰۳-۱.۰۲۷; P < .۰۵). Sensitivity analysis did not change results significantly.   Conclusion Maternal care showed limited associations with the acute conflict, generally reflecting pre-conflict usage patterns. Further qualitative and quantitative research could identify the effects of larger conflicts on maternal care-seeking and usage, and inform approaches to building health system resilience.

Keywords:

Acute Conflict , Maternal Care , Multi-Level Modelling , Egypt