Women and children living in areas of armed conflict in Africa: a geospatial analysis of mortality and orphanhood
Women and children living in areas of armed conflict in Africa: a geospatial analysis of mortality and orphanhood
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生活在非洲武装冲突地区的妇女和儿童：死亡率和孤儿率的地理空间分析
DOI：
10.1016/s2214-109x(19)30407-3
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
E. Bendavid
中科院分区：
文献类型：
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作者：
Z. Wagner;S. Heft;P. Wise;R. Black;M. Burke;T. Boerma;Z. Bhutta;E. Bendavid
背景武装冲突对非战斗人员弱势群体的人口影响尚未完全了解。我们的目的是研究冲突对育龄妇女（15-49岁）的死亡率的影响，并在15岁以下的儿童在Africa.MethodsWe中测试的程度，其中年龄在15-49岁的妇女的死亡率，并在15岁以下的儿童中，在非洲附近的武装冲突中，增加。有关武装冲突的地点、时间和强度的数据来自乌普萨拉冲突数据计划，有关妇女和儿童的地点、时间和结果的数据来自1990年至2016年在35个非洲国家进行的人口与健康调查。妇女的死亡率是从兄弟姐妹的生存数据中获得的。我们使用聚类区域固定效应回归模型来比较附近冲突期间（50公里内）妇女的生存率与同一地区无冲突期间妇女的生存率。我们使用类似的方法来研究生活在武装冲突附近的儿童成为孤儿的风险增加的程度。我们研究了不同的冲突强度的影响，直接战斗死亡人数和持续时间的连续conflict exposure.FindingsWe分析了数据1 629 352名妇女（19 286 387人年），其中103 011（6.3%）死亡（534·1每10万妇女年死亡），和2 354 041名儿童小于15岁，其中204 276（8.7%）失去了父母。 平均而言，50公里范围内的冲突使妇女死亡率增加了112例/10万人年（95%CI 97-128;比基线增加了21%），儿童至少失去父母一方的概率增加了6.0%（95%CI 3-8）。 这一影响是由高强度冲突造成的：与无冲突时期相比，在冲突相关死亡人数最高的十分之一（第10位）冲突中，女性死亡的可能性增加了202%（187-218），而怀孕的可能性增加了42%。在冲突造成的死亡中，10%是由于孕产妇死亡。解读非洲育龄妇女因附近高强度武装冲突而死亡的风险大幅增加。同样，受冲突影响的儿童成为孤儿的风险也增加了。这项工作填补了关于武装冲突对非战斗人员的有害影响的文献空白，并强调需要采取人道主义干预措施保护弱势群体。
BackgroundThe population effects of armed conflict on non-combatant vulnerable populations are incompletely understood. We aimed to study the effects of conflict on mortality among women of childbearing age (15–49 years) and on orphanhood among children younger than 15 years in Africa.MethodsWe tested the extent to which mortality among women aged 15–49 years, and orphanhood among children younger than 15 years, increased in response to nearby armed conflict in Africa. Data on location, timing, and intensity of armed conflicts were obtained from the Uppsala Conflict Data Program, and data on the location, timing, and outcomes of women and children from Demographic and Health Surveys done in 35 African countries from 1990 to 2016. Mortality among women was obtained from sibling survival data. We used cluster-area fixed-effects regression models to compare survival of women during periods of nearby conflict (within 50 km) to survival of women in the same area during times without conflict. We used similar methods to examine the extent to which children living near armed conflicts are at increased risk of becoming orphans. We examined the effects of varying conflict intensity using number of direct battle deaths and duration of consecutive conflict exposure.FindingsWe analysed data on 1 629 352 women (19 286 387 person-years), of which 103 011 (6·3%) died (534·1 deaths per 100 000 women-years), and 2 354 041 children younger than 15 years, of which 204 276 (8·7%) had lost a parent. On average, conflict within 50 km increased women's mortality by 112 deaths per 100 000 person-years (95% CI 97–128; a 21% increase above baseline), and the probability that a child has lost at least one parent by 6·0% (95% CI 3–8). This effect was driven by high-intensity conflicts: exposure to the highest (tenth) decile conflict in terms of conflict-related deaths increased the probability of female mortality by 202% (187–218) and increased the likelihood of orphanhood by 42% compared with a conflict-free period. Among the conflict-attributed deaths, 10% were due to maternal mortality.InterpretationAfrican women of childbearing age are at a substantially increased risk of death from nearby high-intensity armed conflicts. Children exposed to conflict are analogously at increased risk of becoming orphans. This work fills gaps in literature on the harmful effects of armed conflict on non-combatants and highlights the need for humanitarian interventions to protect vulnerable populations.FundingBill & Melinda Gates Foundation to the BRANCH Consortium.