Ecole Régionale de Santé Publique (ERSP), Faculté de Médecine, Université Catholique de Bukavu, Bukavu, DR, Congo.
Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium.
BMC Health Serv Res. 2021 Sep 13;21(Suppl 1):195. doi: 10.1186/s12913-021-06143-7.
In conflict-affected settings, data on reproductive, maternal, newborn and child health (RMNCH) are often lacking for priority setting and timely decision-making. We aimed to describe the levels and trends in RMNCH indicators within Kivu provinces between 2015 and 2018, by linking conflict data with health facility (HF) data from the District Health Information System 2 (DHIS2).
We used data from the DHIS2 for the period 2015-2018, the 2014 Demographic and Health Survey, the 2018 Multiple Indicators Cluster Survey and the Uppsala Conflict Data Program. Health zones were categorised in low, moderate and high conflict intensity level, based on an annual conflict death rate. We additionally defined a monthly conflict death rate and a conflict event-days rate as measures of conflict intensity and insecurity. Outcomes were completion of four antenatal care visits, health facility deliveries, caesarean sections and pentavalent vaccine coverage. We assessed data quality and analyzed coverage and trends in RMNCH indicators graphically, by conflict categories and using HF data aggregated annually. We used a series of fixed-effect regression models to examine the potential dose-response effect of varying conflict intensity and insecurity on RMNCH.
The overall HF reporting was good, ranging between 83.3 and 93.2% and tending to be lower in health zones with high conflict intensity in 2016 and 2017 before converging in 2018. Despite the increasing number of conflict-affected health zones over time, more in North-Kivu than in South-Kivu, we could not identify any clear pattern of variation in RMNCH coverage both by conflict intensity and insecurity. North-Kivu province had consistently reported better RMNCH indicators than South-Kivu, despite being more affected by conflict. The Kivu as a whole recorded higher coverage than the national level. Coverage of RMNCH services calculated from HF data was consistent with population-based surveys, despite year-to-year fluctuation among health zones and across conflict-intensity categories.
Although good in general, the HF reporting rate in the Kivu was negatively impacted by conflict intensity especially at the beginning of the DHIS2's rolling-up. Routine HF data appeared useful for assessing and monitoring trends in RMNCH service coverage, including in areas with high-intensity conflict.
在受冲突影响的环境中，生殖、孕产妇、新生儿和儿童健康（RMNCH）数据通常缺乏优先事项设置和及时决策所需的数据。我们的目的是通过将冲突数据与来自地区卫生信息系统 2（DHIS2）的卫生设施（HF）数据进行链接，来描述基伍省 2015 年至 2018 年期间 RMNCH 指标的水平和趋势。
我们使用了 DHIS2 2015-2018 年的数据、2014 年人口与健康调查、2018 年多指标类集调查和乌普萨拉冲突数据项目的数据。根据每年的冲突死亡人数，将卫生区分为低、中、高强度冲突级别。我们还定义了每月冲突死亡人数和冲突事件天数率作为衡量冲突强度和不安全的指标。结果是完成四次产前保健就诊、卫生设施分娩、剖腹产和五联疫苗覆盖率。我们评估了数据质量，并通过冲突类别和使用每年汇总的 HF 数据以图形方式分析了 RMNCH 指标的覆盖范围和趋势。我们使用一系列固定效应回归模型来检查不断变化的冲突强度和不安全对 RMNCH 的潜在剂量反应效应。
总体而言，HF 报告质量良好，范围在 83.3%至 93.2%之间，并且在 2016 年和 2017 年，高冲突强度的卫生区报告质量往往较低，但在 2018 年趋于收敛。尽管随着时间的推移，受冲突影响的卫生区数量不断增加，北基伍省比南基伍省更多，但我们无法确定 RMNCH 覆盖范围在冲突强度和不安全方面的任何明显变化模式。尽管北基伍省受冲突影响更大，但该省一直报告 RMNCH 指标优于南基伍省。整个基伍地区的覆盖率高于全国水平。尽管卫生区之间以及冲突强度类别之间存在年度波动，但从 HF 数据计算的 RMNCH 服务覆盖率与基于人群的调查结果一致。
尽管总体上良好，但 HF 报告率在基伍地区受到冲突强度的负面影响，尤其是在 DHIS2 滚动阶段的开始时。常规 HF 数据似乎可用于评估和监测 RMNCH 服务覆盖范围的趋势，包括在高强度冲突地区。
