Beyond the battlefield: how conflict type drives acute child malnutrition in Africa

Continuance of global progress toward the eradication of malnutrition in all forms requires the steering of resources to priority areas. Armed conflict is a key driver of malnutrition, yet its impact differs given the conflict intensity, duration and type. In this study, we investigate the relationship between conflict type, specifically state-based and non-state conflict, and under-5 acute malnutrition in conflict-affected African populations.

We link malnutrition data from small-scale surveys held in the Complex Emergency Database, conducted across 11 conflict-affected African populations between 1999 and 2015, with conflict data from UCDP/PRIO. We estimate associations between conflict type and the prevalence of global acute malnutrition (GAM) and severe acute malnutrition (SAM) whilst controlling for relevant covariates, using Bayesian beta-regression, which allows aggregation of survey data.

Holding other factors constant, non-state conflict was significantly (p < 0.05) associated with a higher prevalence of GAM and SAM (15.27% and 4.83%) relative to state-based conflict (9.03% and 1.26%). In addition, we find heterogeneous impacts of prior military expenditure as a share of GDP, overseas development assistance (ODA) and precipitation variability on under-5 acute malnutrition by conflict type. Namely, prior military expenditure and lower-than-normal precipitation were associated with increased malnutrition prevalence under state-based conflict, yet to a lesser degree under non-state conflict. We find a significant mitigating role of ODA on GAM, irrespective of conflict type. For SAM, ODA was more negatively associated with malnutrition prevalence under non-state conflict relative to state-based conflict.

The study extends the current literature by finding a heterogenous relationship between conflict type and under-5 acute malnutrition, namely we estimate a significantly higher malnutrition burden in African populations affected by non-state conflict relative to state-based conflict. Our findings underscore the importance of context-specific resource planning when addressing malnutrition burden in humanitarian crises.