This approximated to 300,000 avoidable maternal deaths and 2 million avoidable infant deaths over the study period. Our models indicate that over the period 2000–2019, armed conflicts classified as wars were associated with an increase of 36.9 maternal deaths per 100,000 live births, an increase of 2.8 infant (under 1 year old) deaths per 1,000 live births, 7.3% lower measles vaccination coverage, and 4.9% lower DPT coverage.We used the models to calculate the number of excess maternal and child deaths that can be attributed to armed conflict. We used panel regression models that included 181 countries. We modelled the association between armed conflicts and maternal and child mortality, deliveries by a skilled birth attendant, and vaccination coverage for measles and diphtheria, pertussis, and tetanus (DPT).Study limitations include the ecological study design, which may mask sub-national variation in conflict intensity, and the quality of the underlying data. No evidence of association between armed conflict and neonatal mortality or delivery by a skilled birth attendant was found.

The long-term impacts of war were demonstrated by associated increases in maternal mortality observed for up to 7 years, in under-5 mortality for 3–5 years, in infant mortality for up to 8 years, in DPT vaccination coverage for up to 3 years, and in measles vaccination coverage for up to 2 years. In adjusted models, conflicts classified as wars were associated with an increase in maternal mortality of 36.9 maternal deaths per 100,000 live births (95% CI 1.9–72.0 0.3 million excess deaths over the study period), an increase in infant mortality of 2.8 per 1,000 live births (95% CI 0.1–5.5 2.0 million excess deaths ), a decrease in DPT vaccination coverage of 4.9% (95% CI 1.5%–8.3%), and a decrease in measles vaccination coverage of 7.3% (95% CI 2.7%–11.8%). Out of 3,718 country–year observations, 522 (14.0%) had minor conflicts and 148 (4.0%) had wars. The number of excess deaths due to conflict was estimated. Further lagged associations up to 10 years post-conflict were tested.

Models were adjusted for 10 confounders, country and year fixed effects, and conflict lagged by 1 year. Secondary outcomes were delivery by a skilled birth attendant and diphtheria, pertussis, and tetanus (DPT) and measles vaccination coverage. Primary outcomes were maternal, under-5, infant, and neonatal mortality rates. Data for 181 countries (2000–2019) from the Uppsala Conflict Data Program and World Bank were analysed using panel regression models.

Hausman fixed random stata 14.0