Peer-reviewed article
Maternal and child healthcare-seeking among victims of violence in armed conflict: a quasi-experimental study in Northeast Nigeria.
Schaub M, Adeyanju GC, Abulfathi AA, Bello MM, Kasserra L et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how experiencing violence in armed conflict affects whether caregivers seek healthcare for their children in northeast Nigeria. Among 3,006 caregivers, 21% had experienced severe violence in the past 3 years. While mothers' own healthcare-seeking was not affected, children of victimised caregivers were much less likely to be fully immunised or receive care at government health facilities. The main reason for reduced healthcare-seeking was that caregivers lost trust in the health system due to health worker absenteeism and violence by state security forces during the conflict.
Key points
- 21% of caregivers in northeast Nigeria experienced severe violence in the past 3 years
- Children of victimised caregivers were 57% less likely to be fully immunised (OR 0.43)
- Children of victimised caregivers were 77% less likely to receive care at government health facilities (OR 0.23)
- Increased distrust in the health system mediated 42-70% of the reduction in healthcare-seeking
- Loss of trust stemmed from health worker absenteeism and victimisation by state security forces during conflict
Limitations
The study captures associations at one point in time and cannot establish the precise timing of when trust was lost relative to healthcare-seeking decisions. The findings are specific to northeast Nigeria and may not generalise to other conflict-affected regions with different contexts or types of violence.
Abstract
Introduction Armed conflict severely impacts health, with indirect deaths often exceeding direct casualties two to four times, disproportionately affecting women and children. Although the magnitude of these effects is well-documented, the mechanisms driving them remain insufficiently understood. This study shifts the focus from supply-side factors, such as the destruction of infrastructure, to demand-side processes, particularly healthcare-seeking behaviour and from broader conflict exposure to individual-level violent victimisation. Methods Data come from a representative survey (n=3006) of caregivers of young children in northeastern Nigeria, a region heavily affected by armed insurgency. Unlike previous studies, our survey included dedicated measures of victimisation, health-seeking outcomes and potential mediating factors within a single instrument, enabling precise measurement and analysis. To compare maternal and child healthcare-seeking behaviour between victimised and non-victimised caregivers, we employed a quasi-experimental observational design using propensity-score matching on demographic and contextual characteristics. Causal mediation analysis was then used to identify the mechanisms linking victimisation to health behaviours. Results Victimisation was widespread, with 21% of respondents (n=651) having experienced a severe form of violence in the past 3 years. While maternal healthcare-seeking behaviour appeared unaffected, victimisation significantly reduced healthcare-seeking for child health. Children of victimised caregivers were markedly less likely to be fully immunised (OR 0.43, p<0.001) and to receive care at government health facilities (OR 0.23, p<0.001). This decline was primarily driven by increased distrust in the health system (proportion mediated: 0.42-0.70, p<0.05), stemming from negative experiences during the conflict, particularly health worker absenteeism and victimisation by state security forces. Conclusion Addressing fear and mistrust is key to improving healthcare-seeking in conflict-affected populations. Efforts should focus on providing security for government-run health facilities, reducing violence against civilians by state security forces and restoring trust in healthcare and state institutions. Future research should explore effective strategies for achieving these objectives.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Not an intervention study—this is an observational study examining the natural relationship between victimisation and healthcare-seeking behaviour
- Population
- 3,006 caregivers of young children in northeast Nigeria, of whom 651 (21%) had experienced severe violence in the past 3 years
Key finding
Victimisation significantly reduced child healthcare-seeking: children of victimised caregivers had OR 0.43 (95% CI) for full immunisation status