The impact of civil conflict on child health: Evidence from Colombia
The impact of civil conflict on child health: Evidence from Colombia
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DOI：
10.1016/j.ehb.2021.101074
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发表时间：
2021-11-25
影响因子：
2.5
通讯作者：
Moreno-Serra, Rodrigo
中科院分区：
文献类型：
--
作者：
Kreif, Noemi;Mirelman, Andrew;Moreno-Serra, Rodrigo
自20世纪中叶以来，国内武装冲突变得更加普遍，具有更大的人身破坏性，对低收入和中等收入国家的健康和发展造成了毁灭性后果。本文采用基于冲突强度的时间和地理变化的识别策略，调查了哥伦比亚长期内部冲突对儿童健康的因果影响。我们估计了不同水平的冲突强度对5岁以下儿童的身高(HAZ)、年龄体重(WAZ)和身高体重z分数的影响，并通过母亲的健康行为和卫生保健利用来探索潜在的机制。我们发现，在子宫和儿童早期暴露于冲突暴力对HAZ和WAZ的有害影响，在整个样本中，甚至在农村样本中更强烈，但这些估计值比对短期冲突的估计要小。潜在的途径似乎在怀孕和分娩期间(以母亲饮酒、产前护理和熟练助产的形式)运行，而不是在出生后期间(通过母乳喂养或接种疫苗)，影响在儿童时期累积。冲突暴力对儿童健康和产妇保健利用的最不利影响发生在武装团体间歇存在的市镇。
Internal armed conflicts have become more common and more physically destructive since the mid-20th century, with devastating consequences for health and development in low-and middle-income countries. This paper investigates the causal impacts of the long-term internal conflict on child health in Colombia, following an identification strategy based on the temporal and geographic variation of conflict intensity. We estimate the effect of different levels of conflict intensity on height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height z-scores among children under five years old, and explore the underlying potential mechanisms, through maternal health behavior and health care utilization. We find a harmful effect of exposure to conflict violence in utero and in early childhood for HAZ and WAZ, in the full sample and even more strongly in the rural sample, yet these estimates are smaller than those found for shorter term conflicts. The underlying pathways appear to operate around the time of the pregnancy and birth (in the form of maternal alcohol use, use of antenatal care and skilled birth attendance), rather than during the post-birth period (via breastfeeding or vaccination), and the impacts accumulate over the childhood. The most adverse impacts of conflict violence on child health and utilization of maternal healthcare were observed in municipalities which suffered from inter-mittent presence of armed groups.