# The impact of civil unrest on child health care: Evidenced by acute medical complications at presentation – A retrospective comparative study

## TL;DR

Civil unrest worsens child healthcare by increasing acute medical complications, especially for rural children.

## Contribution

Demonstrates immediate impact of civil unrest on child healthcare using a PSM-DID approach in Ethiopia.

## Key findings

- Civil unrest increased acute medical complications at hospital presentation.
- Rural children were more affected than urban children during unrest.
- PSM-DID analysis showed a significant DID value of 0.241 (p=0.009).

## Abstract

Civil unrest is a collective term that includes limited political violence, sporadic violent collective action, or nonviolent and mildly violent collective action that causes dissatisfaction over political, economic, or social changes. It had deadly impacts on the lives of children and adolescents. It often results in difficulties for civilian to access basic services including healthcare.

Evaluate the effect of civil unrest on child healthcare provision evidenced by the proportion of children admitted with acute medical complications.

Institution-based retrospective comparative study of Difference in Difference with Propensity Score Matching (PSM-DID) was implemented.

The study was conducted on children admitted to pediatric ward of Bahir Dar University Tibebe-Ghion specialized teaching hospital. Data were collected from medical records for the months of January 01, 2023 – July 31, 2023 (pre-civil unrest) and August 01, 2023 – February 29, 2024 (into the civil unrest), on a retrospective basis. 632 Participants (345 in the treatment and 247 in the control group) were selected randomly using Microsoft Excel based on their medical record number (MRN) from the HMIS registry with treatment assignment (rural residency or not).

PSM was conducted on 7 covariates. In the unmatched sample, significant differences between groups were found for two of the 7 covariates. PSM successfully adjusted for bias in all covariates in the matched sample. The civil unrest has increased acute medical complications at presentation to our hospital for rural residents, with a DID value of 0.241 (p-value = 0.009).

Our study has concluded that civil unrest has an immediate impact on child health care evidenced by an increased proportion of acute medical complications at presentation. It affects more children coming from rural areas compared to those from urban communities.