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Open Access Does the presence of conflict affect maternal and neonatal mortality during Caesarean sections?

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Introduction: Conflicts frequently occur in countries with high maternal and neonatal mortality and can aggravate difficulties accessing emergency care. No literature is available on whether the presence of conflict influences the outcomes of mothers and neonates during Caesarean sections (C-sections) in high-mortality settings.

Objective: To determine whether the presence of conflict was associated with changes in maternal and neonatal mortality during C-sections.

Methods: We analysed routinely collected data on C-sections from 17 Médecins Sans Frontières (MSF) health facilities in 12 countries. Exposure variables included presence and intensity of conflict, type of health facility and other types of access to emergency care.

Results: During 2008–2015, 30,921 C-sections were performed in MSF facilities; of which 55.4% were in areas of conflict. No differences were observed in maternal mortality in conflict settings (0.1%) vs. non-conflict settings (0.1%) (P = 0.08), nor in neonatal mortality between conflict (12.2%) and non-conflict settings (11.5%) (P = 0.1). Among the C-sections carried out in conflict settings, neonatal mortality was slightly higher in war zones compared to areas of minor conflict (P = 0.02); there was no difference in maternal mortality (P = 0.38).

Conclusions: Maternal and neonatal mortality did not appear to be affected by the presence of conflict in a large number of MSF facilities. This finding should encourage humanitarian organisations to support C-sections in conflict settings to ensure access to quality maternity care.
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Keywords: armed conflicts; emergency medicine; maternal health; survival

Document Type: Research Article

Affiliations: 1: Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium 2: Timurgara Hospital, Operational Centre Brussels, Médecins Sans Frontières, Timurgara, Pakistan 3: Operational Centre Brussels, Médecins Sans Frontières, Ahmad Shah Baba Hospital, Kabul, Afghanistan 4: Masisi Hospital, Operational Centre Brussels, Médecins Sans Frontières, Masisi, Democratic Republic of Congo 5: Centre for Research on the Epidemiology of Disasters, Université Catholique de Louvain, Brussels, Belgium

Publication date: September 1, 2019

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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