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Published in: Conflict and Health 1/2018

Open Access 01-12-2018 | Research

The impact of the Boko Haram insurgency in Northeast Nigeria on childhood wasting: a double-difference study

Author: Gillian Dunn

Published in: Conflict and Health | Issue 1/2018

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Abstract

Background

This research examines the relationship between violent conflict and childhood wasting in Northeast Nigeria, where residents have been subjected to fighting between the Nigerian government and Boko Haram - an extremist Islamist movement - since 2009.

Methods

Using two Demographic and Health Surveys from before and after the Boko Haram insurgency started, a double-difference (difference-in-difference) approach is used to assess the impact of the conflict on mean weight-for-height z-scores and the likelihood of wasting.

Results

Results suggest that if children exposed to the conflict had not been exposed, their mean weight-for-height z-score would be 0.49 standard deviations higher (p < 0.001) than it is, increasing from − 0.74 to − 0.25. Additionally, the likelihood of wasting would be 13 percentage points lower (mean z-statistic − 4.2), bringing the proportion down from 23% to 10%.

Conclusion

Descriptive evidence suggests that poor child health outcomes in the conflict areas of Northeast Nigeria may be due to disruptions to social services and increased food insecurity in an already resource poor area. Although other unidentified factors may contribute to both conflict and wasting, the findings underscore the importance of appropriate programs and policies to support children in conflict zones.
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Literature
1.
go back to reference Toole M, Waldman R. The public health aspects of complex emergencies and refugee situations. Annu Rev Public Health. 1997;18:283–312.CrossRefPubMed Toole M, Waldman R. The public health aspects of complex emergencies and refugee situations. Annu Rev Public Health. 1997;18:283–312.CrossRefPubMed
2.
go back to reference Johns Hopkins Bloomberg School of Public Health and the International Federation of Red Cross and Red Crescent Societies. The Johns Hopkins and Red Cross Red Crescent Public Health Guide in Emergencies. 2008. Johns Hopkins Bloomberg School of Public Health and the International Federation of Red Cross and Red Crescent Societies. The Johns Hopkins and Red Cross Red Crescent Public Health Guide in Emergencies. 2008.
3.
go back to reference Moss WJ, Ramakrishnan M, Storms D, et al. Child health in complex emergencies. Geneva: Bulletin of the World Health Organization; 2006. Moss WJ, Ramakrishnan M, Storms D, et al. Child health in complex emergencies. Geneva: Bulletin of the World Health Organization; 2006.
4.
go back to reference World Health Organization. Children: reducing mortality. 2014. World Health Organization. Children: reducing mortality. 2014.
5.
go back to reference Coghlan B, Brennan RJ, Ngoy P, et al. Mortality in the Democratic Republic of Congo: a nationwide survey. Lancet. 2006;367(9504):44–51.CrossRefPubMed Coghlan B, Brennan RJ, Ngoy P, et al. Mortality in the Democratic Republic of Congo: a nationwide survey. Lancet. 2006;367(9504):44–51.CrossRefPubMed
6.
go back to reference Agadjanian V, Prata N. Civil war and child health: regional and ethnic dimensions of child immunization and malnutrition in Angola. Soc Sci Med. 2003;56(12):2515–27.CrossRefPubMed Agadjanian V, Prata N. Civil war and child health: regional and ethnic dimensions of child immunization and malnutrition in Angola. Soc Sci Med. 2003;56(12):2515–27.CrossRefPubMed
7.
go back to reference Brown V, Guerin PJ, Legros D, Paquet C, Pécoul B, Moren A. Research in complex humanitarian emergencies: the Médecins Sans Frontières/epicentre experience. PLoS Med. 2008;5(4):e89.CrossRefPubMedPubMedCentral Brown V, Guerin PJ, Legros D, Paquet C, Pécoul B, Moren A. Research in complex humanitarian emergencies: the Médecins Sans Frontières/epicentre experience. PLoS Med. 2008;5(4):e89.CrossRefPubMedPubMedCentral
8.
go back to reference Internal Displacement Monitoring Centre. Nigeria: Fragmented response to internal displacement amid Boko Haram attacks and flood season. Oslo: Norwegian Refugee Council; 2013. Internal Displacement Monitoring Centre. Nigeria: Fragmented response to internal displacement amid Boko Haram attacks and flood season. Oslo: Norwegian Refugee Council; 2013.
9.
go back to reference Pérouse de Montclos M-A. Nigeria’s interminable insurgency? Addressing the Boko Haram crisis. London, UK: Chatham House, The Royal Institue of International Affairs; 2014. Pérouse de Montclos M-A. Nigeria’s interminable insurgency? Addressing the Boko Haram crisis. London, UK: Chatham House, The Royal Institue of International Affairs; 2014.
10.
go back to reference Reinert M, Garçon L. Boko Haram: a chronology. In: Pérouse de Montclos M-A, editor. Boko Haram: Islamism, politics, security and the state in Nigeria. Vol 2, West African Politics and Society Series. Leiden, Netherlands: African Studies Centre, Institut Français de Recherche en Afrique; 2014. p. 237–45. Reinert M, Garçon L. Boko Haram: a chronology. In: Pérouse de Montclos M-A, editor. Boko Haram: Islamism, politics, security and the state in Nigeria. Vol 2, West African Politics and Society Series. Leiden, Netherlands: African Studies Centre, Institut Français de Recherche en Afrique; 2014. p. 237–45.
11.
go back to reference ACAPS. Secondary data review – 24 august 2015 Northeast Nigeria conflict – Adamawa, Borno, Gombe, and Yobe states. 2015. ACAPS. Secondary data review – 24 august 2015 Northeast Nigeria conflict – Adamawa, Borno, Gombe, and Yobe states. 2015.
12.
go back to reference Mohammed K. The message and methods of Boko Haram. In: Pérouse de Montclos M-A, editor. Boko Haram: Islamism, politics, security and the state in Nigeria Vol 2, West African Politics and Society Series. Leiden, Netherlands: African Studies Centre, Institut Français de Recherche en Afrique; 2014. p. 9–32. Mohammed K. The message and methods of Boko Haram. In: Pérouse de Montclos M-A, editor. Boko Haram: Islamism, politics, security and the state in Nigeria Vol 2, West African Politics and Society Series. Leiden, Netherlands: African Studies Centre, Institut Français de Recherche en Afrique; 2014. p. 9–32.
14.
go back to reference Aliaga A, Ren R. Optimal sample sizes for two-stage cluster sampling in demographic and health surveys. 2006. Aliaga A, Ren R. Optimal sample sizes for two-stage cluster sampling in demographic and health surveys. 2006.
17.
go back to reference Rutsein SO, Johnson K. The DHS Wealth Index. Calverton: The DHS Program; 2004. Rutsein SO, Johnson K. The DHS Wealth Index. Calverton: The DHS Program; 2004.
18.
go back to reference WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Core questions on drinking-water and sanitation for household surveys; 2006. p. 24. WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation. Core questions on drinking-water and sanitation for household surveys; 2006. p. 24.
19.
go back to reference Gascón J, Vargas M, Schellenberg D, et al. Diarrhea in children under 5 years of age from Ifakara, Tanzania: a case-control study. J Clin Microbiol. 2000;38(12):4459–62.PubMedPubMedCentral Gascón J, Vargas M, Schellenberg D, et al. Diarrhea in children under 5 years of age from Ifakara, Tanzania: a case-control study. J Clin Microbiol. 2000;38(12):4459–62.PubMedPubMedCentral
20.
go back to reference Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51.CrossRefPubMed Black RE, Victora CG, Walker SP, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51.CrossRefPubMed
21.
go back to reference Buvinic M, Das Gupta M, Casabonne U, Verwimp P. Violent conflict and gender inequality: an overview. World Bank Res Obs. 2013;28(1):110–38.CrossRef Buvinic M, Das Gupta M, Casabonne U, Verwimp P. Violent conflict and gender inequality: an overview. World Bank Res Obs. 2013;28(1):110–38.CrossRef
22.
go back to reference Brewer M, Crossley TF, Joyce R. Inference with difference-in-differences revisited. Forschungsinstitut zur Zukunft der Arbeit / Institute for the Study of Labor: Bonn, Germany; 2013. Brewer M, Crossley TF, Joyce R. Inference with difference-in-differences revisited. Forschungsinstitut zur Zukunft der Arbeit / Institute for the Study of Labor: Bonn, Germany; 2013.
23.
go back to reference Dickson L, Pender M. Do in-state tuition benefits affect the enrollment of non-citizens? Evidence from universities in Texas. Econ Educ Rev. 2013;37:126–37.CrossRef Dickson L, Pender M. Do in-state tuition benefits affect the enrollment of non-citizens? Evidence from universities in Texas. Econ Educ Rev. 2013;37:126–37.CrossRef
24.
go back to reference Norton EC, Wang H, Ai C. Computing interaction effects and standard errors in logit and probit models. Stata J. 2004;4(2):154–67. Norton EC, Wang H, Ai C. Computing interaction effects and standard errors in logit and probit models. Stata J. 2004;4(2):154–67.
25.
go back to reference Lechner M. The estimation of causal effects by difference-in-difference methods. Foundations Trends Econometrics. 2010;4(3):165–224.CrossRef Lechner M. The estimation of causal effects by difference-in-difference methods. Foundations Trends Econometrics. 2010;4(3):165–224.CrossRef
26.
go back to reference World Food Programme and Centers for Disease Control and Prevention. A Manual: Measuring and Interpreting Malnutrition and Mortality. Rome: World Food Programme and Centers for Disease Control and Prevention; 2005. World Food Programme and Centers for Disease Control and Prevention. A Manual: Measuring and Interpreting Malnutrition and Mortality. Rome: World Food Programme and Centers for Disease Control and Prevention; 2005.
28.
go back to reference Leroy JL. zscore06: Stata command for the calculation of anthropometric z-scores using the 2006 WHO child growth standards. 2011. Leroy JL. zscore06: Stata command for the calculation of anthropometric z-scores using the 2006 WHO child growth standards. 2011.
29.
go back to reference World Health Organization, United Nations High Commissioner for Refugees, International Federation of Red Cross, World Food Programme. The management of nutrition in major emergencies. 2000. World Health Organization, United Nations High Commissioner for Refugees, International Federation of Red Cross, World Food Programme. The management of nutrition in major emergencies. 2000.
30.
go back to reference UNICEF, World Health Organization, World Bank Group. Levels and trends in child malnutrition: UNICEF – WHO – World Bank Group joint child malnutrition estimates: key findings of the 2015 edition. 2015. UNICEF, World Health Organization, World Bank Group. Levels and trends in child malnutrition: UNICEF – WHO – World Bank Group joint child malnutrition estimates: key findings of the 2015 edition. 2015.
31.
go back to reference IRIN. Updated timeline of Boko Haram attacks and related violence. 2013. IRIN. Updated timeline of Boko Haram attacks and related violence. 2013.
33.
go back to reference Watchlist on Children and Armed Conflict. “Who will care for us?” Grave violations against children in northeastern Nigeria. New York: Watchlist on Children and Armed Conflict; 2014. Watchlist on Children and Armed Conflict. “Who will care for us?” Grave violations against children in northeastern Nigeria. New York: Watchlist on Children and Armed Conflict; 2014.
36.
go back to reference Galhena DH, Freed R, Maredia KM. Home gardens: a promising approach to enhance household food security and wellbeing. Agriculture & Food Security. 2013;2(1):8.CrossRef Galhena DH, Freed R, Maredia KM. Home gardens: a promising approach to enhance household food security and wellbeing. Agriculture & Food Security. 2013;2(1):8.CrossRef
37.
go back to reference UNICEF. Committing to child survival: a promise renewed. Progress report 2015. 2015. UNICEF. Committing to child survival: a promise renewed. Progress report 2015. 2015.
38.
39.
go back to reference National Population Commission (Nigeria) and ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: National Population Commission (Nigeria) andICF International; 2014. National Population Commission (Nigeria) and ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: National Population Commission (Nigeria) andICF International; 2014.
Metadata
Title
The impact of the Boko Haram insurgency in Northeast Nigeria on childhood wasting: a double-difference study
Author
Gillian Dunn
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Conflict and Health / Issue 1/2018
Electronic ISSN: 1752-1505
DOI
https://doi.org/10.1186/s13031-018-0136-2

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