@article{fdi:010090667,
  title = {{I}mproving healthcare accessibility for pregnant women and children in the context of health system strengthening initiatives and terrorist attacks in {C}entral {M}ali : a controlled interrupted time series analysis},
  author = {{Z}ombr{\'e}, {D}. and {D}iarra, {D}. and {T}our{\'e}, {L}. and {B}onnet, {E}mmanuel and {R}idde, {V}al{\'e}ry},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {T}he {H}ealth and {S}ocial {D}evelopment {P}rogram of the {M}opti {R}egion ({PADSS}2) project, launched in {M}ali's {M}opti region, targeted {U}niversal {H}ealth {C}overage ({UHC}). {T}he project addressed demand-side barriers by offering an additional subsidy to household contributions, complementing existing {S}tate support (component 1). {C}omponent 2 focused on supply-side improvements, enhancing quality and coverage. {C}omponent 3 strengthened central and decentralised capacity for planning, supervision and {UHC} reflection, integrating gender mainstreaming. {T}he study assessed the impact of the project on maternal and child healthcare use and explored how rising terrorist activities might affect these health outcomes.{M}ethods {T}he impact of the intervention on assisted births, prenatal care and curative consultations for children under 5 was analysed from {J}anuary 2016 to {D}ecember 2021. {T}his was done using an interrupted time series analysis, incorporating a comparison group and spline regression.{R}esults {C}1 increased assisted deliveries by 0.39% (95% {CI} 0.20 to 0.58] and {C}2 by 1.52% (95% {CI} 1.36 to 1.68). {C}1-enhanced first and fourth antenatal visits by 1.37% (95% {CI} 1.28 to 1.47) and 2.07% (95% {CI} 1.86 to 2.28), respectively, while {C}2 decreased them by 0.53% and 1.16% (95% {CI} -1.34 to -0.99). {F}or child visits under 5, {C}1 and {C}2 showed increases of 0.32% (95% {CI} 0.20 to 0.43) and 1.36% (95% {CI} 1.27 to 1.46), respectively. {I}n areas with terrorist attacks, child visits decreased significantly by 24.69% to 39.86% compared with unexposed areas.{C}onclusion {T}he intervention had a limited impact on maternal and child health, falling short of expectations for a health system initiative. {U}nderstanding the varied effects of terrorism on healthcare is key to devising strategies that protect the most vulnerable in the system.},
  keywords = {{M}aternal health ; {C}hild health ; {H}ealth services research ; {MALI}},
  booktitle = {},
  journal = {{BMJ} {G}lobal {H}ealth},
  volume = {7},
  numero = {{S}uppl. 9},
  pages = {e012816 [11 ]},
  ISSN = {2059-7908},
  year = {2024},
  DOI = {10.1136/bmjgh-2023-012816},
  URL = {https://www.documentation.ird.fr/hor/fdi:010090667},
}