Presentation (CTI)

OBJECTIVES: Health service disruptions driven by armed conflict remain a major barrier to maternal health in Nigeria’s Sahel region. Understanding these pathways is essential to guide resource allocation and policy in fragile settings. The study aims to quantify the economic burden associated with conflict-related maternal health service disruptions and assess real-world utilization patterns among women of reproductive age in conflict-affected Sahelian LGAs in Borno, Yobe, and northern Adamawa States.
METHODS: A cross-sectional study using real-world data from 18 primary healthcare facilities and 1,247 women (15-49 years) was conducted from January to September 2025. Facility-level metrics were linked with household cost data obtained through two-stage cluster sampling. Direct medical costs, direct nonmedical costs, and productivity losses were estimated using a microcosting approach from the societal perspective. Insecurity intensity was measured using a monthly incident index derived from ACLED event classifications. Service disruption scores were constructed using modified WHO Service Availability and Readiness indicators. Multivariable logistic regression evaluated associations between insecurity and facility-based maternal service utilization.
RESULTS: Sixty-four percent of facilities reported conflict-related disruptions, resulting in a 23% decline in ANC attendance and a 31% reduction in skilled birth deliveries. The mean cost per pregnancy episode in high-conflict LGAs was US$118 compared with US$44 in low-conflict areas, with productivity losses comprising 41% of total costs. Transportation, out-of-pocket fees, and informal payments accounted for 63% of nonmedical expenditures. Women residing ≥5 km from disrupted facilities had significantly lower odds of facility delivery (aOR 0.48; 95% CI: 0.36-0.64). Facilities experiencing ≥3 insecurity incidents monthly were more likely to report stockouts of essential maternal commodities (p < 0.01).
CONCLUSIONS: Conflict markedly increases maternal healthcare costs and reduces facility utilization across Sahelian Nigeria. These findings provide critical HEOR evidence to inform conflict-sensitive financing models, strengthen service delivery, and guide resource allocation for maternal health resilience in fragile settings.