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Service utilization patterns for childbirth and neonatal mortality in the occupied Palestinian territory during
Zeina Ali Siam1, Tiziana Leone2
1Graduate School of Arts and Sciences, Harvard University, Cambridge, MA, USA.
Insights
Conflict intensity in the occupied Palestinian territory was linked to fewer births in private and NGO facilities. However, conflict intensity did not increase neonatal mortality after 2004.
Area of Science:
- Global health
- Conflict studies
- Neonatal outcomes
Background:
- Increasing global incidence of man-made crises necessitates understanding conflict's impact on healthcare.
- Evidence on service utilization during conflict is crucial for addressing adverse neonatal outcomes.
Purpose of the Study:
- To assess the association between conflict intensity in the occupied Palestinian territory (oPt) at the time of birth and childbirth provider utilization.
- To examine the relationship between conflict intensity and neonatal mortality.
Main Methods:
- Utilized data from four demographic and health surveys (2004-2014) in the oPt.
- Combined survey data with conflict intensity metrics (casualties per 100,000 population).
- Employed multivariate logistic and multinomial regressions to analyze associations between conflict and outcomes.
Main Results:
- High conflict intensity correlated with reduced childbirths in private (RR=0.97) and NGO (RR=0.95) sectors compared to public facilities.
- No significant association was found between conflict intensity and increased neonatal mortality after 2004.
Conclusions:
- Highlights the need for enhanced public sector preparedness for childbirth services during conflict.
- Suggests further investigation into factors contributing to the persistent decline in neonatal mortality beyond conflict timing.
Background:
The global incidence of man-made crises has increased in the last decade. Evidence on deviations in service uptake during conflict is needed to better understand the link between conflict and adverse neonatal outcomes. We assessed the association between conflict intensity in the occupied Palestinian territory (oPt) at time of birth and (i) utilization patterns for childbirth across different providers; and (ii) neonatal mortality.
Methods:
We combined data on conflict intensity with four demographic and health surveys (2004, 2006, 2010 and 2014) that included nationally representative samples of women of childbearing age. Our exposure variable was casualties per 100 000 population in defined sub-regions of the oPt. Our outcome specifications were a binary variable for neonatal deaths and a categorical variable for childbirth location. We used multivariate logistic and multinomial regressions to assess the associations.
Results:
High conflict intensity was associated with fewer childbirths in the private sector (RR=0.97, P=0.04), and non-governmental organizations (RR=0.95, P=0.03) compared to public facilities. Conflict intensity was not associated with higher neonatal mortality beyond 2004.
Conclusions:
Policy implications include better preparedness in the public sector for childbirth during conflict and exploring reasons for the slow decline in neonatal mortality in the territory beyond conflict at time of birth.
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