Armed Violent Conflicts and Healthcare-Seeking Behaviour for Maternal and Child Health in Sub-Saharan Africa: A Systematic Review

Background: Over 630 million women and children worldwide face displacement due to conflict or resided dangerously close to conflicts zones. While the adverse effects of physical destruction on healthcare delivery are relatively well understood, the effects on healthcare-seeking behavior remain underexplored, especially in sub-Saharan Africa. This study aims at the interconnections and knowledge gaps between exposure to armed violent conflicts and healthcare-seeking behaviors for maternal and child health in Sub-Saharan Africa.  Methods: Five key electronic databases (PubMed, Scopus, Web of Science, PsycNET, and African Journals Online) were searched for peer-reviewed publications between 2000 and 2022. The review was designed according to PRISMA-P statement and the protocol was registered with PROSPERO database. The methodological quality and risks of bias were appraised using GRADE. A data extraction instrument was modelled along the Cochrane Handbook for Systematic Reviews and the Centre for Reviews and Dissemination of Systematic Reviews.  Result: The search results yielded 1,148 publications. Only twenty-one studies met the eligibility criteria, reporting healthcare-seeking behaviors for maternal and child health. Among the twenty-one studies, seventeen (81.0%) reported behaviors for maternal health such as antenatal care, skilled birth attendance, postnatal care services, and family planning.Similarly, nine studies (42.8%) observed behaviors for child health such as vaccination uptake, case management for pneumonia, diarrhea, malnutrition, and cough. While conflict exposure is generally associated with less favorable healthcare-seeking behavior, in some of the studies, healthcare outcomes improved. Marital status, male partner’s attitude, education, income and poverty levels were associated with healthcare-seeking behavior.  Conclusion: There is need for multifaceted interventions to mitigate the repercussions of armed violent conflicts on healthcare-seeking behavior, given its mixed effects on child and maternal healthcare utilization. While armed violent conflict disproportionately affects child compared to maternal health, it is noteworthy that, exposure to such conflicts may unintentionally also lead to positive outcomes. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript. In addition, other datasets used and/or analyzed are available on https://osf.io/gnkyc/