Health Conditions of Particular Concern to Maternal Child Health Populations in Post-Invasion Iraq: A Comparison Between Data Sources

Reproductive age women and children face injuries, higher rates of infectious diseases, and limited health seeking behavior in times of armed conflict – all of which can contribute to adverse health outcomes. This cross-sectional study evaluated the burden (prevalence) of 16 diseases of particular concern to maternal and child health populations from the early days of the occupation in 2004 to post-occupation in 2016 using Iraq Surveillance data, collected by the Iraq Ministry of Health, as well as Global Burden of Disease (GBD) data collected by the Institute of Health Metrics and Evaluation (IHME). We used Joinpoint to determine early-post analyses of prevalence ratios for each data source and to conduct trend analyses. For each health condition, we examined the relative difference between the average of yearly prevalence rates from 2004 and 2016 between the two data sources by subtracting the Iraq Surveillance data measurements from the GBd data (Table 1). The GBD data generally reported more cases in the conditions of interest than the surveillance data, although the overall trends were similar in both datasets. For example, based on the Iraq Surveillance data, the average of the yearly prevalence rates of Hepatitis B was 7.98 cases per 100,000 people. The relative difference between GBD and Iraq Surveillance Data was 126.25 cases per 100,000 people, while based on the GBD data, the average of the yearly prevalence was 134.23 per 100,000 people. Furthermore, Iraq Surveillance data identified outbreaks of several conditions (e.g. measles and sexual assault) that were not reported in GBD data. GBD and Iraq Surveillance data were in closest agreement for the prevalence of common childhood conditions (chickenpox, diphtheria, pertussis). Both datasets indicated there was either a decrease or a marginal increase (<10% increase) in all diseases from 2004 to 2016. In sum, both datasets, the Iraq Surveillance data and the GBD data, are useful in understanding the burden from these health conditions and had limitations. Further research to address these limitations will improve understanding of health conditions of reproductive age women and under five children in Iraq, which in turn will facilitate the effort to improve maternal and child health in Iraq.