Wagner Z, et al. - Authors evaluated the extent to which armed conflict is an important cause of child mortality, especially in Africa. In Africa, substantial and persistent increase in the infant mortality is seen by armed conflict, with effect sizes on a scale with malnutrition and several times greater than existing estimates of the mortality burden of conflict. The indirect toll of conflict on civilian populations and the importance of developing interventions to address child health in areas of conflict are underscored by the toll of conflict on children, who are presumably not combatants.

Methods

• Researchers matched child survival with proximity to armed conflict using information in the Uppsala Conflict Data Program Georeferenced Events Dataset on the location and intensity of armed conflict from 1995 to 2015 together with the location, timing, and survival of infants younger than 1 year (primary outcome) in 35 African countries.
• They measured the increase in mortality risk for infants exposed to armed conflicts within 50 km in the year of birth and studied conflicts' extended health risks, up to 250 km away and 10 years before birth.
• The impacts of conflicts of varying intensity and chronicity (conflicts lasting several years), and effect heterogeneity by residence and sex of the child were also examined.
• Then the number and portion of deaths of infants younger than 1 year related to conflict were estimated.

Results

• As per data, experts identified 15,441 armed conflict events that led to 968,444 combat-related deaths and matched these data with 1·99 million births and 133,361 infant deaths (infant mortality of 67 deaths per 1000 births) between 1995 and 2015.
• They noted 5·2 per 1000 births at a higher risk of dying before reaching age 1 year of a child born within 50 km of an armed conflict than being born in the same region during periods without conflict (95% CI 3·7–6·7; a 7·7% increase above baseline).
• Findings suggested that this increased risk of dying ranged from a 3·0% increase for armed conflicts with 1 to 4 deaths to a 26·7% increase for armed conflicts with more than 1000 deaths.
• Researchers found evidence of increased mortality risk from an armed conflict up to 100 km away, and for 8 years after conflicts, with cumulative increase in infant mortality 2 to 4 times higher than the contemporaneous increase.
• From 1995 to 2015, the number of infant deaths related to conflict was between 3·2 and 3·6 times the number of direct deaths from armed conflicts in the entire continent.