Leone Tiziana, Alburez-Gutierrez Diego, Ghandour Rula, Coast Ernestina, Giacaman Rita
1Department of International Development, London School of Economics and Political Science, London, UK.
2Department of Social Policy, London School of Economics and Political Science, London, UK.
Confl Health. 2019 Aug 7;13:36. doi: 10.1186/s13031-019-0220-2. eCollection 2019.
In the occupied Palestinian territory (oPt), access to maternal and child healthcare (MCH) services are constrained due to the prolonged Israeli military occupation, the Separation Wall, army checkpoints, and restrictions on the movement of people and goods. This study assesses the relationship between conflict intensity and access to Maternal and Child Health care in occupied Palestinian territory (oPt). To the best of our knowledge, the impact of conflict on access to health care has not been measured due to the lack of data.
We analyse pooled data from household surveys covering a fifteen-year period (2000-2014) of children ( = 16,793) and women ( = 8477) in five regions of the oPt. Conflict intensity was used as a continuous variable defined as the square root of non-combatant conflict mortality taken from monthly death rates of non-combatants by region. We use multilevel logistic models to explain four outputs: child vaccination schedules, antenatal care, caesarean sections, and complications during pregnancy.
Locality is important with results showing the negative impact of conflict intensity on access to care, especially in the South West Bank for maternal health services and Central West Bank for vaccination (B - 0.161 = 0.000 for DPT). Wealth is only significant for DPT vaccinations with poorest (B - 0.098 = 0.005) and poor (B - 0.148 = 0.002) individuals less likely to access services. Otherwise conflict does not show a differential effect across socio-economic conditions.
This study shows how locality is the strongest factor when looking at the impact of conflict in the oPt. Preventative services (ANC and vaccinations) are the most affected by conflict. We recommend a greater use of community health care to improve access to maternal and child care when barriers impede access to health facilities during times of conflict.
在巴勒斯坦被占领土（oPt），由于以色列长期军事占领、隔离墙、军队检查站以及对人员和货物流动的限制，母婴保健（MCH）服务的获取受到制约。本研究评估了冲突强度与巴勒斯坦被占领土（oPt）母婴保健服务获取之间的关系。据我们所知，由于缺乏数据，冲突对医疗服务获取的影响尚未得到衡量。
我们分析了来自家庭调查的汇总数据，这些数据涵盖了巴勒斯坦被占领土五个地区15年期间（2000 - 2014年）的儿童（n = 16,793）和妇女（n = 8477）。冲突强度被用作一个连续变量，定义为非战斗人员冲突死亡率的平方根，该死亡率取自各地区非战斗人员的月度死亡率。我们使用多层次逻辑模型来解释四个结果：儿童疫苗接种计划、产前护理、剖腹产以及孕期并发症。
地区因素很重要，结果显示冲突强度对医疗服务获取有负面影响，特别是在约旦河西岸西南部的孕产妇保健服务以及约旦河西岸中部的疫苗接种方面（白喉、百日咳、破伤风混合疫苗（DPT）的B值为 - 0.161，p = 0.000）。财富因素仅对白喉、百日咳、破伤风混合疫苗接种有显著影响，最贫困者（B值为 - 0.098，p = 0.005）和贫困者（B值为 - 0.148，p = 0.002）获得服务的可能性较小。否则，冲突在不同社会经济状况下并未显示出差异影响。
本研究表明，在审视巴勒斯坦被占领土冲突的影响时，地区因素是最主要的因素。预防性服务（产前护理和疫苗接种）受冲突影响最大。我们建议在冲突期间当进入卫生设施受阻时，更多地利用社区医疗保健来改善母婴护理服务的获取。
