@article{fdi:010087523,
  title = {{E}volution of assisted deliveries at primary healthcare centres in an unstable security context in {M}ali},
  author = {{B}onnet, {E}mmanuel and {L}erosier, {T}. and {T}oure, {L}. and {D}iarra, {Y}. and {D}iabate, {S}. and {D}iarra, {D}. and {R}idde, {V}al{\'e}ry},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {I}n {M}ali, healthcare systems are severely affected by conflict. {H}owever, several studies suggest a lack of knowledge about its impact on maternal healthcare. {F}requent and repeated attacks increase insecurity, limit access to maternal care, and thus represent a barrier to accessing care. {T}he objective of this study is to understand how assisted deliveries are being reorganised at the health centre level, and how they are adapting to the security crisis. {M}ethod{T} his is a mixed sequential and explanatory study. {T}he quantitative approaches combine a spatial scan analysis of assisted deliveries by health centres, an analysis of health centre performance using an ascending hierarchical classification, and a spatial analysis of violent events in two health districts in central {M}ali: {M}opti and {B}andiagara. {T}he qualitative phase analyses semidirective and targeted interviews with managers (n=22) of primary healthcare centres ({C}s{COM}) and two agents of international institutions. {R}esults {T}he study reveals an important territorial heterogeneity of assisted deliveries. {T}he primary health centres with high rates of assisted deliveries have mainly high-performance levels. {T}his high level of use can be explained by the movement of the population to areas less exposed to attacks. {T}he centres with low rates of assisted deliveries are those where qualified health workers refused to practice, where populations had few financial resources, and where they limited their travel to reduce their exposure to insecurity.{C}onclusion{T}his study confirms that combining methodological approaches is essential to explain significant use in the local context. {T}he analysis of the number of assisted deliveries in conflict zones must consider the number of procedures, the nearby security context, the number of internally displaced persons and the presence of camps in which humanitarian organisations offer programmes.},
  keywords = {{M}aternal health ; {MALI}},
  booktitle = {},
  journal = {{BMJ} {G}lobal {H}ealth},
  volume = {7},
  numero = {{S}uppl. 9},
  pages = {e010811 [10 ]},
  ISSN = {2059-7908},
  year = {2023},
  DOI = {10.1136/bmjgh-2022-010811},
  URL = {https://www.documentation.ird.fr/hor/fdi:010087523},
}