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Armed conflict and child mortality in Africa: a geospatial analysis.

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Title: Armed conflict and child mortality in Africa: a geospatial analysis.
Authors: Wagner, Zachary, Heft-Neal, Sam, Bhutta, Zulfiqar A., Black, Robert E., Burke, Marshall, Bendavid, Eran
Source: Lancet. 9/8/2018, Vol. 392 Issue 10150, p857-865. 9p.
Subjects: Child mortality, Children & war, Children, Geospatial data, War, Comparative studies, Infant mortality, Research methodology, Medical cooperation, Public health surveillance, Research, Research funding, Risk assessment, World health, Evaluation research, Statistical models
Geographic Terms: Africa
Abstract: Background: A substantial portion of child deaths in Africa take place in countries with recent history of armed conflict and political instability. However, the extent to which armed conflict is an important cause of child mortality, especially in Africa, remains unknown.Methods: We matched child survival with proximity to armed conflict using information in the Uppsala Conflict Data Program Georeferenced Events Dataset on the location and intensity of armed conflict from 1995 to 2015 together with the location, timing, and survival of infants younger than 1 year (primary outcome) in 35 African countries. We measured the increase in mortality risk for infants exposed to armed conflicts within 50 km in the year of birth and, to study conflicts' extended health risks, up to 250 km away and 10 years before birth. We also examined the effects of conflicts of varying intensity and chronicity (conflicts lasting several years), and effect heterogeneity by residence and sex of the child. We then estimated the number and portion of deaths of infants younger than 1 year related to conflict.Findings: We identified 15 441 armed conflict events that led to 968 444 combat-related deaths and matched these data with 1·99 million births and 133 361 infant deaths (infant mortality of 67 deaths per 1000 births) between 1995 and 2015. A child born within 50 km of an armed conflict had a risk of dying before reaching age 1 year of 5·2 per 1000 births higher than being born in the same region during periods without conflict (95% CI 3·7-6·7; a 7·7% increase above baseline). This increased risk of dying ranged from a 3·0% increase for armed conflicts with one to four deaths to a 26·7% increase for armed conflicts with more than 1000 deaths. We find evidence of increased mortality risk from an armed conflict up to 100 km away, and for 8 years after conflicts, with cumulative increase in infant mortality two to four times higher than the contemporaneous increase. In the entire continent, the number of infant deaths related to conflict from 1995 to 2015 was between 3·2 and 3·6 times the number of direct deaths from armed conflicts.Interpretation: Armed conflict substantially and persistently increases infant mortality in Africa, with effect sizes on a scale with malnutrition and several times greater than existing estimates of the mortality burden of conflict. The toll of conflict on children, who are presumably not combatants, underscores the indirect toll of conflict on civilian populations, and the importance of developing interventions to address child health in areas of conflict.Funding: The Doris Duke Charitable Foundation, and the Centre for Global Child Health at the Hospital for Sick Children. [ABSTRACT FROM AUTHOR]
Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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PubType: Academic Journal
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  Data: Armed conflict and child mortality in Africa: a geospatial analysis.
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  Data: <searchLink fieldCode="AR" term="%22Wagner%2C+Zachary%22">Wagner, Zachary</searchLink><br /><searchLink fieldCode="AR" term="%22Heft-Neal%2C+Sam%22">Heft-Neal, Sam</searchLink><br /><searchLink fieldCode="AR" term="%22Bhutta%2C+Zulfiqar+A%2E%22">Bhutta, Zulfiqar A.</searchLink><br /><searchLink fieldCode="AR" term="%22Black%2C+Robert+E%2E%22">Black, Robert E.</searchLink><br /><searchLink fieldCode="AR" term="%22Burke%2C+Marshall%22">Burke, Marshall</searchLink><br /><searchLink fieldCode="AR" term="%22Bendavid%2C+Eran%22">Bendavid, Eran</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Lancet%22">Lancet</searchLink>. 9/8/2018, Vol. 392 Issue 10150, p857-865. 9p.
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  Data: <searchLink fieldCode="DE" term="%22Child+mortality%22">Child mortality</searchLink><br /><searchLink fieldCode="DE" term="%22Children+%26+war%22">Children & war</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Geospatial+data%22">Geospatial data</searchLink><br /><searchLink fieldCode="DE" term="%22War%22">War</searchLink><br /><searchLink fieldCode="DE" term="%22Comparative+studies%22">Comparative studies</searchLink><br /><searchLink fieldCode="DE" term="%22Infant+mortality%22">Infant mortality</searchLink><br /><searchLink fieldCode="DE" term="%22Research+methodology%22">Research methodology</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+cooperation%22">Medical cooperation</searchLink><br /><searchLink fieldCode="DE" term="%22Public+health+surveillance%22">Public health surveillance</searchLink><br /><searchLink fieldCode="DE" term="%22Research%22">Research</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Risk+assessment%22">Risk assessment</searchLink><br /><searchLink fieldCode="DE" term="%22World+health%22">World health</searchLink><br /><searchLink fieldCode="DE" term="%22Evaluation+research%22">Evaluation research</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+models%22">Statistical models</searchLink>
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  Data: <bold>Background: </bold>A substantial portion of child deaths in Africa take place in countries with recent history of armed conflict and political instability. However, the extent to which armed conflict is an important cause of child mortality, especially in Africa, remains unknown.<bold>Methods: </bold>We matched child survival with proximity to armed conflict using information in the Uppsala Conflict Data Program Georeferenced Events Dataset on the location and intensity of armed conflict from 1995 to 2015 together with the location, timing, and survival of infants younger than 1 year (primary outcome) in 35 African countries. We measured the increase in mortality risk for infants exposed to armed conflicts within 50 km in the year of birth and, to study conflicts' extended health risks, up to 250 km away and 10 years before birth. We also examined the effects of conflicts of varying intensity and chronicity (conflicts lasting several years), and effect heterogeneity by residence and sex of the child. We then estimated the number and portion of deaths of infants younger than 1 year related to conflict.<bold>Findings: </bold>We identified 15 441 armed conflict events that led to 968 444 combat-related deaths and matched these data with 1·99 million births and 133 361 infant deaths (infant mortality of 67 deaths per 1000 births) between 1995 and 2015. A child born within 50 km of an armed conflict had a risk of dying before reaching age 1 year of 5·2 per 1000 births higher than being born in the same region during periods without conflict (95% CI 3·7-6·7; a 7·7% increase above baseline). This increased risk of dying ranged from a 3·0% increase for armed conflicts with one to four deaths to a 26·7% increase for armed conflicts with more than 1000 deaths. We find evidence of increased mortality risk from an armed conflict up to 100 km away, and for 8 years after conflicts, with cumulative increase in infant mortality two to four times higher than the contemporaneous increase. In the entire continent, the number of infant deaths related to conflict from 1995 to 2015 was between 3·2 and 3·6 times the number of direct deaths from armed conflicts.<bold>Interpretation: </bold>Armed conflict substantially and persistently increases infant mortality in Africa, with effect sizes on a scale with malnutrition and several times greater than existing estimates of the mortality burden of conflict. The toll of conflict on children, who are presumably not combatants, underscores the indirect toll of conflict on civilian populations, and the importance of developing interventions to address child health in areas of conflict.<bold>Funding: </bold>The Doris Duke Charitable Foundation, and the Centre for Global Child Health at the Hospital for Sick Children. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1016/S0140-6736(18)31437-5
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      – Code: eng
        Text: English
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        PageCount: 9
        StartPage: 857
    Subjects:
      – SubjectFull: Child mortality
        Type: general
      – SubjectFull: Children & war
        Type: general
      – SubjectFull: Children
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      – SubjectFull: Geospatial data
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      – SubjectFull: War
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      – SubjectFull: Comparative studies
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      – SubjectFull: Infant mortality
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      – SubjectFull: Medical cooperation
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      – SubjectFull: Statistical models
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      – SubjectFull: Africa
        Type: general
    Titles:
      – TitleFull: Armed conflict and child mortality in Africa: a geospatial analysis.
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              Text: 9/8/2018
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              Y: 2018
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