[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-113458-en":3,"doc-seo-113458-105":29,"detail-sidebar-cat-0-en-105":91},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":13,"seo_description":14,"update_tm":27,"read_time":28},113458,962075114101,"Seraphina","https://ap-avatar.wpscdn.com/avatar/e000253a75eb197efd?x-image-process=image/resize,m_fixed,w_180,h_180&k=1780044092746381165",8,"Research & Report","Disrupted Service Delivery? The Impact of Conflict on Antenatal Care Quality in Kenya - Original Research","Conflict-affected contexts in Africa face elevated maternal mortality, yet evidence on how conflict alters the quality of maternal health services remains limited. This study estimated the effect of conflict exposure on antenatal care (ANC) quality in Kenya using 553 ANC visits from January to April 2010. Process quality worsened near conflict events, while management and supervision showed a countervailing increase; equipment and infrastructure showed no significant change.","Public Disclosure Authorized Public Disclosure Authorized  \nORIGINAL RESEARCH  \npublished: 26 February 2021  \ndoi: 10 .3389/fgwh.2021.599731  \n\n|  |  |  |\n| --- | --- | --- |\n|  |  |  |\n|  | Disrupted Service Delivery? The |  |\n|  | Impact of Con􀀂ict on Antenatal Care |  |\n|  | Quality in Kenya |  |\n|  | Adanna Chukwuma 1*, Kerry L. M. Wong 2 and Uche Eseosa Ekhator-Mobayode 1 |  |\n|  | 1 World Bank Group, Washington, DC, United States, 2 Faculty of Epidemiology and Population Health, London School of |  |\n|  | Hygiene and Tropical Medicine, London, United Kingdom |  |\n|  | Introduction: African countries facing con􀀂ict have higher levels of maternal mortality. |  |\n|  | Understanding the gaps in the utilization of high-quality maternal health care is essential |  |\n|  | to improving maternal survival in these states. Few studies have estimated the impact |  |\n|  | of con􀀂ict on the quality of health care. In this study, we estimated the impact of con􀀂ict |  |\n|  | on the quality of health care in Kenya, a country with multiple overlapping con􀀂icts and |  |\n|  | signi􀀀cant disparities in maternal survival. |  |\n| Edited by: | Materials and Methods: We drew on data on the observed quality of 553 antenatal |  |\n| Tabassum Firoz,\u003Cbr>Yale New Haven Health System, United States | care (ANC) visits between January and April 2010 . Process quality was measured asthe percentage of elements of client–provider interactions performed in these visits. For |  |\n| Reviewed by:\u003Cbr>Bilal Ahmed Usmani, | structural quality, we measured the percentage of required components of equipment and infrastructure and the management and supervision in the facility on the day of the |  |\n| NED University of Engineering and Technology, Pakistan\u003Cbr>Triphonie Nkurunziza, | visit. We spatially linked the analytical sample to con􀀂ict events from January to April 2010. We modeled the quality of ANC as a function of exposure to con􀀂ict using spatial |  |\n| World Health Organization—Regional Of􀀀ce for Africa, Republic of Congo\u003Cbr>*Correspondence:\u003Cbr>Adanna Chukwuma | difference-in-difference models.\u003Cbr>Results: ANC visits that occurred in facilities within 10,000 m of any con􀀂ict event in a high-con􀀂ict month received 18–21 percentage points fewer components of process |  |\n| [achukwuma@worldbank.org](achukwuma@worldbank.org) | quality on average and had a mean management and supervision score that was |  |\n| Specialty section:\u003Cbr>This article was submitted to | 12.8–13.5 percentage points higher. There was no signi􀀀cant difference in the mean equipment and infrastructure score at the 5% level. The positive impact of con􀀂ict |  |\n| Maternal Health,\u003Cbr>a section of the journal Frontiers in Global Women’s Health | exposure on the quality of management and supervision was driven by rural facilities. The quality of management and supervision and equipment and infrastructure did not |  |\n| Received: 28 August 2020 | modify the impact of con􀀂ict on process quality. |  |\n| Accepted: 28 January 2021\u003Cbr>Published: 26 February 2021\u003Cbr>Citation:\u003Cbr>ChukwumaA, Wong KLM and | Discussion: Our study demonstrates the importance of designing maternal health policy based on the context-speci􀀀c evidence on the mechanisms through which con􀀂ict affects health care. In Kenya, deterioration of equipment and infrastructure does not |  |\n| Ekhator-Mobayode UE (2021) Disrupted Service Delivery? The Impact of Con􀀂ict onAntenatal Care Quality in Kenya. | appear to be the main mechanism through which con􀀂ict has affected ANC quality. Further research should focus on better understanding the determinants of the gaps in process quality in con􀀂ict-affected settings, including provider motivation, competence, |  |\n| Front. Glob. Womens Health\u003Cbr>2:599731. | and incentives. |  |\n| doi: 10.3389/fgwh.2021.599731 | Keywords: antenatal care, con􀀂ict, violence, quality of care, maternal health, Kenya |  |\n\nFrontiers in Global Women’[s Health | www.frontiersin.org](s Health | www.frontiersin.org) 1 Fe","cbCaitdQ66L4HwAq","https://ap.wps.com/l/cbCaitdQ66L4HwAq","pdf",423786,1,14,"English","en",105,"# Introduction\n## Materials and Methods\n## Results\n## Discussion","[{\"question\":\"How does conflict exposure affect antenatal care (ANC) process quality in Kenya?\",\"answer\":\"ANC visits occurring within 10,000 m of conflict events during high-conflict months received 18–21 percentage points fewer components of process quality on average.\"},{\"question\":\"What happens to management and supervision scores in facilities exposed to conflict?\",\"answer\":\"The mean management and supervision score was 12.8–13.5 percentage points higher, with the positive impact driven by rural facilities.\"},{\"question\":\"Does conflict exposure significantly change equipment and infrastructure quality?\",\"answer\":\"No significant difference in the mean equipment and infrastructure score was found at the 5% level.\"}]",1784504640,35,{"code":4,"msg":30,"data":31},"ok",{"site_id":24,"language":23,"slug":32,"title":13,"keywords":33,"description":14,"schema_data":34,"social_meta":86,"head_meta":88,"extra_data":90,"updated_unix":27},"disrupted-service-delivery-the-impact-of-conflict-on-antenatal-care-quality-in-kenya-original-research","",{"@graph":35,"@context":85},[36,53,68],{"@type":37,"itemListElement":38},"BreadcrumbList",[39,43,47,50],{"item":40,"name":41,"@type":42,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":44,"name":45,"@type":42,"position":46},"https://docshare.wps.com/document/","Document",2,{"item":48,"name":12,"@type":42,"position":49},"https://docshare.wps.com/document/research-report/",3,{"item":51,"name":13,"@type":42,"position":52},"https://docshare.wps.com/document/disrupted-service-delivery-the-impact-of-conflict-on-antenatal-care-quality-in-kenya-original-research/113458/",4,{"url":51,"name":13,"@type":54,"author":55,"headline":13,"publisher":57,"fileFormat":60,"inLanguage":23,"description":14,"dateModified":61,"datePublished":62,"encodingFormat":60,"isAccessibleForFree":63,"interactionStatistic":64},"DigitalDocument",{"name":9,"@type":56},"Person",{"url":40,"name":58,"@type":59},"DocShare","Organization","application/pdf","2026-07-20","2026-07-19",true,{"@type":65,"interactionType":66,"userInteractionCount":20},"InteractionCounter",{"@type":67},"ViewAction",{"@type":69,"mainEntity":70},"FAQPage",[71,77,81],{"name":72,"@type":73,"acceptedAnswer":74},"How 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