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The Maoist insurgency (1996-2006) and child health indicators in Nepal
11414 Paresky, Williams College, Williamstown, MA 01267, USA.
Insights
Child health in Nepal improved during the Maoist insurgency, with better vaccination coverage and lower mortality rates. However, conflict-affected regions saw slower progress, especially in nutrition.
Area of Science:
- Child Health
- Epidemiology
- Public Health
Background:
- The Communist Party of Nepal-Maoist (CPN-Maoist) insurgency (1996-2006) impacted public health systems in Nepal.
- Understanding the association between conflict and child health indicators is crucial for targeted interventions.
Purpose of the Study:
- To examine the impact of the CPN-Maoist insurgency on child health indicators in Nepal.
- To analyze national and subregional trends in vaccination coverage, mortality rates, and nutritional status.
Main Methods:
- Analysis of national and subregional data on neonatal tetanus protection, measles and diphtheria-pertussis-tetanus (DPT) vaccine coverage.
- Examination of trends in infant mortality, under-5 mortality, and the proportion of underweight or stunted children.
- Comparison of Nepal's child health improvements with Bangladesh and India.
Main Results:
- Overall improvements in vaccination coverage were observed, but measles and DPT coverage stagnated during conflict years.
- Infant and under-5 mortality rates declined, though improvements in stunting and underweight children were less pronounced.
- Conflict-affected regions showed less improvement in health indicators compared to less-affected areas and national averages.
Conclusions:
- Easily deliverable health interventions like vaccinations showed improvements, but were less effective in high-conflict zones.
- Child nutrition indicators, requiring complex, coordinated interventions and sustained access, were less successful.
- Continued investment in child health delivery systems is vital for comprehensive improvements across all indicators.
Abstract:
The association of conflict and child health indicators in Nepal was examined for the period of the Communist Party of Nepal-Maoist (CPN-Maoist) insurgency (1996-2006). National and subregional trends in neonatal protection against tetanus, measles and diphtheria-pertussis-tetanus (DPT) vaccine coverage, infant mortality, under-5 mortality, and proportion of underweight or stunted children were examined. During the period of the insurgency there were overall improvements in vaccination coverage; however, measles vaccine and DPT coverage remained static during several years of conflict. A decline in infant and under-5 mortality rates occurred: however, there were smaller improvements in stunting and underweight children. Improvements in health indicators from the Mid-western Hill subregion of the country, an area that was consistently conflict-affected, were less than those achieved nationally or by the less-affected Eastern Hill subregion. In comparison with Bangladesh and India, improvements in Nepal were the same or better, except for stunting and underweight children. Health interventions that are more easily delivered, such as vaccination, showed improvements, although the changes were less in a region of high conflict. Improvements in child nutrition indicators that necessitate multiple, coordinated interventions and access to at-risk populations over time as well as ongoing food security were not as successful. Continued commitment to development of systems for delivery of child health is important to gain improvements across all childhood health indicators.
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