Chukwuma Adanna, Wong Kerry L M, Ekhator-Mobayode Uche Eseosa
World Bank Group, Washington, DC, United States.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Front Glob Womens Health. 2021 Feb 26;2:599731. doi: 10.3389/fgwh.2021.599731. eCollection 2021.
African countries facing conflict have higher levels of maternal mortality. Understanding the gaps in the utilization of high-quality maternal health care is essential to improving maternal survival in these states. Few studies have estimated the impact of conflict on the quality of health care. In this study, we estimated the impact of conflict on the quality of health care in Kenya, a country with multiple overlapping conflicts and significant disparities in maternal survival. We drew on data on the observed quality of 553 antenatal care (ANC) visits between January and April 2010. Process quality was measured as the percentage of elements of client-provider interactions performed in these visits. For structural quality, we measured the percentage of required components of equipment and infrastructure and the management and supervision in the facility on the day of the visit. We spatially linked the analytical sample to conflict events from January to April 2010. We modeled the quality of ANC as a function of exposure to conflict using spatial difference-in-difference models. ANC visits that occurred in facilities within 10,000 m of any conflict event in a high-conflict month received 18-21 percentage points fewer components of process quality on average and had a mean management and supervision score that was 12.8-13.5 percentage points higher. There was no significant difference in the mean equipment and infrastructure score at the 5% level. The positive impact of conflict exposure on the quality of management and supervision was driven by rural facilities. The quality of management and supervision and equipment and infrastructure did not modify the impact of conflict on process quality. Our study demonstrates the importance of designing maternal health policy based on the context-specific evidence on the mechanisms through which conflict affects health care. In Kenya, deterioration of equipment and infrastructure does not appear to be the main mechanism through which conflict has affected ANC quality. Further research should focus on better understanding the determinants of the gaps in process quality in conflict-affected settings, including provider motivation, competence, and incentives.
面临冲突的非洲国家孕产妇死亡率更高。了解高质量孕产妇保健服务利用方面的差距对于提高这些国家的孕产妇生存率至关重要。很少有研究估计冲突对医疗保健质量的影响。在本研究中，我们估计了冲突对肯尼亚医疗保健质量的影响，该国存在多重重叠冲突且孕产妇生存率存在显著差异。我们利用了2010年1月至4月期间553次产前检查（ANC）观察到的质量数据。过程质量通过这些就诊中进行的医患互动要素的百分比来衡量。对于结构质量，我们测量了设备和基础设施所需组件的百分比以及就诊当天设施中的管理和监督情况。我们将分析样本与2010年1月至4月的冲突事件进行了空间关联。我们使用空间差分模型将ANC质量建模为冲突暴露的函数。在高冲突月份距离任何冲突事件10000米范围内设施中的ANC就诊，平均过程质量要素少18 - 21个百分点，管理和监督平均得分高(12.8 - 13.5)个百分点。在5%的水平上，设备和基础设施平均得分没有显著差异。农村设施推动了冲突暴露对管理和监督质量的积极影响。管理和监督质量以及设备和基础设施并没有改变冲突对过程质量的影响。我们的研究表明，根据冲突影响医疗保健的具体机制的特定背景证据来设计孕产妇健康政策非常重要。在肯尼亚，设备和基础设施的恶化似乎不是冲突影响ANC质量的主要机制。进一步的研究应侧重于更好地理解受冲突影响环境中过程质量差距的决定因素，包括提供者的动机、能力和激励措施。
