Child health outcomes and care-seeking in a frozen conflict: results from a household survey

Abstract Background Children and adolescents are particularly vulnerable in fragile and conflict-affected settings (FACS) and tend to be disproportionately affected due to fragile health systems and uncertain geopolitical contexts. To better understand child health in a frozen conflict, we examined health outcomes and care-seeking behaviors among the indigenous people of Nagorno-Karabakh during a ceasefire period prior to their forced displacement. Methods Multistage cluster sampling was used to sample 1023 households in Nagorno-Karabakh during the summer of 2022. From each household, one woman aged 18-49 participated in an interviewer-administered survey. Child health outcomes and care-seeking behaviors were assessed among all married women with at least one child under 5 years. Results A total of 196 women provided information on 265 children under 5 years. In the 2 weeks preceding the survey: 8.3% had ARI symptoms, with 68.2% seeking care (20.0% within 2 days); 12.8% had fever, with 61.8% seeking care (35.0% within 2 days), and 82.4% taking medications; and 9.4% had diarrhea, with 84.0% seeking care (43.0% within 2 days), and 96.0% taking medications, of which 56.0% used ORS. Main reasons for not seeking treatment included improvement in condition and home-care. Among these women, 70.7% and 52.7% had sufficient knowledge about when to seek care for cough and diarrhea, respectively. Conclusions The burden of common childhood illnesses was considerable, yet the proportion and timing of care-seeking were suboptimal. The prevalence of illness and inadequate care-seeking knowledge and behavior could be due to the fragility of the healthcare system and general situation of a protracted frozen conflict. Campaigns to improve child health-related knowledge are essential to protect the health of the displaced children of Nagorno-Karabakh. Considering the scarcity of data on children in conflict zones, these findings reinforce the urgent need to prioritize child health in FACS. Key messages • Children in Nagorno-Karabakh were affected by common childhood illnesses, yet care-seeking knowledge and behaviors were less than satisfactory, potentially due to the frozen conflict. • Future studies should focus on increasing child health-related knowledge as well as examining the impact of forced displacement on child health among the displaced population of Nagorno-Karabakh.