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Centre for Global Child Health

Armed conflicts have contributed to five million deaths of children under age five in Africa over 20 years: new study

Impact of armed conflict on child mortality in Africa may be on a par with malnutrition

An estimated five million children under the age of five and three million infants aged one or younger died due to armed conflicts in Africa between 1995 and 2015—a burden several times higher than previous estimates. The new estimates were published in The Lancet on August 30, 2018.

The study highlights the enormous toll of conflict on children not involved in combat who die from direct injures as well as easily preventable diseases such as dysentery or measles, or from hunger and malnutrition, and underscore the importance of improving child health in areas of conflict.

“The impact of modern war generates a series of lethal but indirect impacts on communities caused by preventable infectious diseases, malnutrition, and disruption of basic services such as water, sanitation, vaccinations, and medical care. Many of these deaths are potentially preventable, and much more could be done to improve maternal and child health during and after armed conflicts,” says Dr. Eran Bendavid of Stanford University, who led the study.

Dr. Zulfiqar Bhutta, Co-Director, SickKids Centre for Global Child Health is one of the authors of the study.

“Our analysis suggests that civilian infant deaths are three times higher than those directly involved in conflict. This sheds new light on the enormous burden of conflict on child mortality in Africa. Much more needs to be done to address the needs of women and children who are impacted by armed conflict. Our findings also indicate that conflict is a significant risk factor of child mortality, and one that has been largely underestimated,” says Bhutta.

Since 1989, three-quarters of domestic armed conflicts worldwide have taken place in Africa. The extent to which armed conflicts such as civil wars, rebellions, and interstate conflicts drive child mortality has been largely unmeasured and poorly understood.

To explore this further, the researchers analysed data from the Uppsala Conflict Aata Program including 35 of 54 countries in Africa involving 15,441 conflict events that resulted in 968,444 armed-conflict deaths between 1995 and 2015. They used the information to geospatially link 1.9 million births and 204,101 child and 133,361 infant deaths from nationally representative Demographic Health Surveys (DHS) to armed conflict events, and then estimated the risk of death for infants (younger than one year) and children (under age five) according to proximity to the armed conflict and time after conflict resolution (i.e. lingering conflict effects). The regional baseline infant mortality rate (expected in a normal situation) was 67 deaths per 1,000 births.

Results showed that infants born within 50 km of an armed conflict event had a greater (7.7 per cent) risk of dying in their first year of life compared to those born in the same region during years without conflict (corresponding to an absolute increase of 5.2 deaths per 1,000 births; from 67 deaths per 1,000 births to 72.2 deaths per 1,000 births).

This increase in mortality risk also rose with exposure to conflicts with higher intensity—with the risk rising to 69 deaths per 1,000 births for conflicts during which up to four people died and as high as 85 deaths per 1,000 births for conflicts in which more than 1,000 people were killed. Infant mortality was also four times higher in conflicts lasting five consecutive years or more compared to less than one year (78.7 deaths per 1,000 births versus 69.8 deaths per 1,000 births).

Importantly, this higher risk of dying persisted up to distances of 100 km from a conflict event and for children born up to eight years after conflicts subsided.

The researchers then estimated that armed conflicts throughout Africa (including all 54 countries) have resulted in the deaths of an extra 3.1 to 3.5 million infants (6.6 to 7.3 per cent of all infant deaths over the 20-year period) and 4.9 to 5.5 million children under age five (6.6 to 7.4 per cent of all deaths in children under five) between 1995 and 2015—10 times higher than the Global Burden of Disease 2015 estimates which reported that conflict accounts for less than 0.4 per cent of child deaths.  

Further analyses revealed that conflict heightened the risk of stunting and neonatal mortality, suggesting possible harms to maternal health and care during pregnancy, labour, and delivery.

The researchers caution that the measurement of child deaths due to conflict is beset with data and methodological issues that might affect the accuracy of the estimates, not least the difficulties of collecting data in conflict situations, the imprecise nature of location information, and the effect of conflict-induced migration.