在冲突环境中向妇女、儿童和青少年提供卫生干预措施:从十个国家案例研究中学到了什么?
Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies?
机构信息
Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK.
Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada.
出版信息
Lancet. 2021 Feb 6;397(10273):533-542. doi: 10.1016/S0140-6736(21)00132-X. Epub 2021 Jan 24.
Armed conflict disproportionately affects the morbidity, mortality, and wellbeing of women, newborns, children, and adolescents. Our study presents insights from a collection of ten country case studies aiming to assess the provision of sexual, reproductive, maternal, newborn, child, and adolescent health and nutrition interventions in ten conflict-affected settings in Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Syria, and Yemen. We found that despite large variations in contexts and decision making processes, antenatal care, basic emergency obstetric and newborn care, comprehensive emergency obstetric and newborn care, immunisation, treatment of common childhood illnesses, infant and young child feeding, and malnutrition treatment and screening were prioritised in these ten conflict settings. Many lifesaving women's and children's health (WCH) services, including the majority of reproductive, newborn, and adolescent health services, are not reported as being delivered in the ten conflict settings, and interventions to address stillbirths are absent. International donors remain the primary drivers of influencing the what, where, and how of implementing WCH interventions. Interpretation of WCH outcomes in conflict settings are particularly context-dependent given the myriad of complex factors that constitute conflict and their interactions. Moreover, the comprehensiveness and quality of data remain limited in conflict settings. The dynamic nature of modern conflict and the expanding role of non-state armed groups in large geographic areas pose new challenges to delivering WCH services. However, the humanitarian system is creative and pluralistic and has developed some novel solutions to bring lifesaving WCH services closer to populations using new modes of delivery. These solutions, when rigorously evaluated, can represent concrete response to current implementation challenges to modern armed conflicts.
武装冲突不成比例地影响到妇女、新生儿、儿童和青少年的发病率、死亡率和福利。我们的研究提供了来自十个国家案例研究的见解,旨在评估在阿富汗、哥伦比亚、刚果民主共和国、马里、尼日利亚、巴基斯坦、索马里、南苏丹、叙利亚和也门这十个受冲突影响的环境中提供性健康、生殖健康、孕产妇健康、新生儿健康、儿童健康和青少年健康以及营养干预的情况。我们发现,尽管在背景和决策过程方面存在很大差异,但在这十个冲突环境中,产前护理、基本紧急产科和新生儿护理、综合紧急产科和新生儿护理、免疫接种、常见儿童疾病的治疗、婴儿和幼儿喂养以及营养不良的治疗和筛查被优先考虑。许多拯救生命的妇女和儿童健康(WCH)服务,包括大多数生殖、新生儿和青少年健康服务,并未在这十个冲突环境中报告提供,也没有针对死产的干预措施。国际捐助者仍然是影响实施 WCH 干预措施的内容、地点和方式的主要驱动力。鉴于构成冲突的无数复杂因素及其相互作用,在冲突环境中对 WCH 结果的解释特别依赖于背景。此外,冲突环境中的数据的全面性和质量仍然有限。现代冲突的动态性质和非国家武装团体在大片地区扩大作用,给提供 WCH 服务带来了新的挑战。然而,人道主义系统是创造性和多元化的,已经开发出一些新的解决方案,通过新的交付模式,使拯救生命的 WCH 服务更接近人群。这些解决方案,如果经过严格评估,可以代表对现代武装冲突实施挑战的具体应对措施。