Abstract
Background: United Nations’ (UN) data indicate that conflict-affected low- and middle-income countries (LMICs)
contribute considerably to global maternal deaths. Maternal care usage patterns during conflict have not been
rigorously quantitatively examined for policy insights. This study analysed associations between acute conflict and
maternal services usage and quality in Egypt using reliable secondary data (as conflict-affected settings generally lack
reliable primary data).
Methods: An uncontrolled before-and-after study used data from the 2014 Egypt Demographic and Health Survey
(EDHS). The ‘pre-conflict sample’ included births occurring from January 2009 to January 2011. The ‘peri-conflict
sample’ included births from February 2011 to December 2012. The hierarchical nature of demographic and
household survey (DHS) data was addressed using multi-level modelling (MLM).
Results: In total, 2569 pre-conflict and 4641 peri-conflict births were reported. After adjusting for socioeconomic
variables, conflict did not significantly affect antenatal service usage. Compared to the pre-conflict period, periconflict births had slightly lower odds of delivery in public institutions (odds ratio [OR]: 0.987; 95% CI: 0.975-0.998;
P<.05), institutional postnatal care (OR: 0.995; 95% CI: 0.98-1.00; P=.05), and at least 24 hours post-delivery stay
(OR: 0.921; 95% CI: 0.906-0.935; P<.01). Peri-conflict births had relatively higher odds of doctor-assisted deliveries
(OR: 1.021; 95% CI: 1.004-1.035; P<.05), institutional deliveries (OR: 1.022; 95% CI: 1.00-1.04; P<.05), private
institutional deliveries (OR: 1.035; 95% CI: 1.017-1.05; P<.001), and doctor-assisted postnatal care (OR: 1.015; 95%
CI: 1.003-1.027; P<.05). Sensitivity analysis did not change results significantly.
Conclusion: Maternal care showed limited associations with the acute conflict, generally reflecting pre-conflict usage
patterns. Further qualitative and quantitative research could identify the effects of larger conflicts on maternal careseeking and usage, and inform approaches to building health system resilience