Does armed conflict impact maternal heath? A report from rural Haiti

Article type: Research Article

Authors: Small, Maria | Magee, Edward | Colimon, IveCarm | Frederic, Rikerdy | Williams, Keith P. | Kershaw, Trace

Affiliations: Duke University Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Durham, NC 27710, USA | University of San Diego School of Medicine, San Diego, CA 92093, USA | Hospital Albert Schweitzer, Obstetrics and Gynecology, Deschapelle, Haiti | Hospital Albert Schweitzer, Obstetrics and Gynecology, Division of Community Medicine, Deschapelle, Haiti | Hospital of St. Raphael Department of Obstetrics and Gynecology, New Haven, CT 06511, USA | Yale University School of Public Health, Division of Social and Behavioral Epidemiology, New Haven, CT 06511, USA

Note: [] Corresponding author: Maria Small, MD MPH, Duke University Department of Obstetrics and Gynecology, Division of Material Fetal Medicine, DUMC 3967, Durham, NC 27710, USA. Tel.: +1 919 681 5220; Fax: +1 919 681 7861; E-mail: maria.small@duke.edu; smallmaria@hotmail.com

Abstract: Objectives: Few works address the impact of armed conflict on obstetric outcomes, largely secondary to limitations in measurement of these outcomes. In settings where hospitalized data is routinely and consistently obtained, these sources may provide rapidly accessible and valuable information on the status of women. The objective of this work was to determine the impact of the armed conflict of February, 2004 on maternal health in rural Haiti. Methods: Study of data from the Hospital Albert Schweitzer perinatal database from the time of conflict in February, 2004 was compared to baseline indices from the preceding year, 2003. Primary outcome measures included: maternal mortality, eclampsia, and stillbirth. Results: In 2003, maternal deaths occurred in 0.8% of women at baseline, compared to 4% during the conflict. (p=0.03) The baseline eclampsia rates were 0.5% and rose to 14% during the 2004 conflict. (p=0.06) Surrounding hospital closures resulted in a marginally significant increase in patients from outside the hospital catchement area. Conclusions: In areas of poverty, access to care is one of the most significant determinants of health. Peaks in maternal mortality may reflect obstructions in access to care during times of acute instability. These data may serve as markers for the social status of women, the function of the local health care system, and the international response to conflict, as experienced, by the most vulnerable members of the population.

Keywords: Conflict, maternal mortality, eclampsia, preeclampsia, Haiti

Journal: Journal of Neonatal-Perinatal Medicine, vol. 1, no. 2, pp. 105-109, 2008