PhD Defense Presentation_Primus Che Chi_06.03.2016.pptx_updated
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This document summarizes the PhD dissertation of Primus Che Chi on the impact of armed conflict on maternal and reproductive health in Sub-Saharan Africa. The dissertation used quantitative regression analysis and qualitative interviews to examine the effects of conflict on maternal mortality, fertility rates, and access to maternal health services in Burundi and Northern Uganda. Key findings included that armed conflict is associated with increased maternal and infant mortality, poor access and quality of maternal health services, and complex individual and systemic barriers to effective emergency obstetric and neonatal care in post-conflict settings. The dissertation concluded that armed conflicts have substantial negative impacts on maternal health and recommended prioritizing emergency obstetric services, integrating refugee health services, and coordinating the equitable delivery
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PhD Defense Presentation_Primus Che Chi_06.03.2016.pptx_updated
- 1. Impact of armed conflict on maternal and reproductive health in Sub-Saharan Africa Primus Che Chi PhD Disputation, Kreftsenteret Auditorium March 9, 2016
- 2. Acknowledgements Supervisors ? Professor Henrik Urdal ? Professor Johanne Sundby Adjudication committee ? Senior Advisor Michael Tawanda ? Senior Research Fellow Helge Brunborg ? Associate Professor Benedikte Lindskog Institutions: Faculty of Medicine, UiO and PRIO Family, friends & colleagues PhD Defense_Primus Che Chi 2
- 3. Overview ? Background ? Purpose of the study ? Study design and procedures ? Key findings and discussion ? Conclusions ? Recommendations PhD Defense_Primus Che Chi 3
- 4. Background Armed conflict: ? Public health problem. ? Important contributor to the social and political determinants of health. ? Driver of poverty and health inequity. ? Leading to poor maternal and child outcomes. PhD Defense_Primus Che Chi 4
- 5. Purpose of the study Aim To assess the impact of armed conflict on maternal and reproductive health (MRH) in sub-Saharan Africa ? Case studies of recent post-conflict societies: Burundi and Northern Uganda Objectives: ? Impact of armed conflict on maternal mortality and fertility levels ? Stakeholders¡¯ perceptions of the effects of armed conflict on MRH services and outcomes ? Determinants of women¡¯s utilisation of MRH services ? Barriers to the effective delivery of emergency obstetric and neonatal care (EmONC) PhD Defense_Primus Che Chi 5
- 6. Study design & procedures ?Multidisciplinary and multi-method ?Quantitative: Cross-national time-series regression analysis (IV: Armed conflict; DV: MMR & TFR). ?Qualitative: semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs) with key stakeholders (health providers, women of reproductive age, policy-makers etc.) in Burundi & Northern Uganda. PhD Defense_Primus Che Chi 6
- 7. Key findings and discussion PhD Defense_Primus Che Chi 7
- 8. Model 1 Model 2 Model 3 Model 4 Battle-related deaths (ln) 0.008 (0.007) -0.008 (0.006) -0.031*** (0.007) -0.001 (0.007) Neighboring conflict 0.009 (0.008) 0.006 (0.007) 0.004 (0.007) -0.015 (0.008) Battledeaths (ln)* Poverty 0.035*** (0.006) 1970-74 (reference category) 1975-79 -0.208** (0.070) 0.154* (0.074) 0.134 (0.072) 0.045 (0.080) 1980-84 -0.345*** (0.070) 0.287** (0.088) 0.231** (0.087) 0.197* (0.098) 1985-89 -0.556*** (0.083) 0.324** (0.107) 0.270* (0.105) 0.256* (0.122) 1990-94 -0.829*** (0.092) 0.292* (0.125) 0.213 (0.123) 0.243 (0.147) Constant 16.51*** (1.018) 17.33*** (1.420) 15.33*** (1.185) 17.55*** (1.794) N 1,124 1,018 1,018 668 R sq, overall 0.03 0.15 0.16 0.10 Armed conflict and total fertility rates, 1970-2005 PhD Defense_Primus Che Chi 8
- 9. Armed conflict and maternal mortality rates, 1990-2005 Model 5 Model 6 Model 7 Model 8 Battle-related deaths (ln) 0.012* (0.005) 0.007 (0.005) 0.007 (0.006) 0.003 (0.006) Neighboring conflict -0.014** (0.005) -0.013** (0.005) -0.013** (0.005) 0.006 (0.007) Battledeaths (ln)* Poverty -0.0003 (0.004) 1990-94 (reference category) 1995-99 -0.155*** (0.032) -0.133*** (0.032) -0.133*** (0.032) 0.169** (0.059) 2000-04 -0.280*** (0.109) -0.238*** (0.043) -0.238*** (0.044) 0.076* (0.035) HIV prevalence 0.052*** (0.008) Population (ln) 0.256 (0.132) 0.245 (0.142) 0.243 (0.143) 0.247 (0.245) Constant 2.882* (1.149) 5.060*** (1.341) 3.068* (1.244) 5.832* (2.286) N 561 532 532 354 R sq, overall 0.05 0.40 0.40 0.54 PhD Defense_Primus Che Chi 9
- 10. Key findings: Qualitative studies PhD Defense_Primus Che Chi 10 Country Study areas Participants/ Informants Total Women LHPs NGOs Burundi Bujumbura Marie and Ngozi provinces 11 Interviews & 2 FGDs 9 Interviews & 1 FGD 11 Interviews & 1 FGD 31 interviews & 4 FGDs Uganda Northern Uganda 10 Interviews & 2 FGD 12 Interviews & 1 FGD 10 Interviews & 1 FGD 32 interviews & 4 FGDs All countries 21 interviews & 4 FGDs 21 interviews & 2 FGDs 21 interviews and 2 FGDs 63 interviews & 8 FGDs
- 11. Key finding 2 ¨C Effects of conflict The perceived effects of the conflict on MRH outcomes included: ? increased maternal and newborn morbidity and mortality ? high prevalence of HIV/AIDS and SGBV ? increased levels of prostitution, teenage pregnancy and clandestine abortion ? high fertility levels ?Relocation to government recognized IDP camps reportedly improved access to health services for many women PhD Defense_Primus Che Chi 11
- 12. Armed conflict and access and quality of MRH services Event ? Armed conflict Mechanisms ?Destruction of health facilities ?Looting of medical supplies at health facilities ?Shutdown of health facilities ?Fleeing of local health providers from conflict zone ?Limited movement to operational health facilities due to insecurity ?Irregular opening hours of health facilities ?Disruption of medical supplies to health facilities ?Displacement of populations away from health facilities ?Targeted killing of local health providers (Burundi) ?Favouritism in the provision of health services on ethnic basis (Burundi) ?Abduction of health providers (N .Uganda) Outcomes ?Poor access to MRH services ?Limited access to MRH services ?Poor quality MRH services PhD Defense_Primus Che Chi 11
- 13. Key finding 3 ¨C Determinants: utilisation PhD Defense_Primus Che Chi 13
- 14. Key finding 4 ¨C Barriers: EmONC Study settings Themes Subthemes Burundi Northern Uganda Human resources-related challenges Acute shortage of trained personnel X X Demoralised personnel and perceived lack of recognition X Perceived poor living conditions and poor remuneration for personnel X X High personnel turnover X X Increasing workload and high burn-out X X High levels of staff absenteeism in rural health centres X Poor level of coordination among key EmONC personnel resulting in delays to provide emergency services X Systemic and institutional failures Poorly operational ambulance service for referrals X Inefficient drug supply system X Inefficient referral system X Lack of essential installations, supplies and medications X X Poor allocation of limited resources X Poor harmonization and coordination of EmONC training curriculum nationally X Weak/ incomprehensive training curriculum X Poor data collection and monitoring system X X Inequity in the distribution of EmONC facilities between urban and rural areas X X PhD Defense_Primus Che Chi 14
- 15. Conclusions ? Armed conflicts have a substantial negative impact on MRH ? In post-conflict settings, women¡¯s utilization of MRH services is affected by a complex set of factors cutting across the individual, socio- cultural, political and health system domains. ? The delivery of EmONC services post-conflict health systems is hampered by a series of human resources-related challenges, and systemic and institutional failures. PhD Defense_Primus Che Chi 15
- 16. Recommendations ? Prioritise the delivery of quality EmONC services. ? Integration of refugees and/or IDPs health services with those of local host communities. ? Bridge ethnic, religious or political inequalities in the delivery of health services . ? Coordinate the location and construction of IDP camps with local government. PhD Defense_Primus Che Chi 16
Editor's Notes
- #5: Impact on health systems: directly and indirectly, and short-term and long-term, leading to poor maternal and child outcomes.
- #7: (public health & demography) , : qualitative and quantitative data and research techniques.
- #16: incl. health services and health outcomes that linger well into the post-conflict phase.