The world's longest running civil war and chronic childhood undernutrition in Myanmar: a propensity score matched analysis
Abstract
Background: Childhood undernutrition remains a major public health challenge in low- and middle-income countries (LMICs), particularly in settings affected by armed conflict and fragility. Prolonged civil conflict disrupts livelihoods, food systems and service delivery, yet its nutritional consequences remain poorly quantified. This study assesses the association between regional exposure to armed conflict and chronic childhood undernutrition in Myanmar.
Methods: We linked nationally representative data obtained from the 2015-16 Myanmar Demographic and Health Survey with conflict event records from the Uppsala Conflict Data Program (2010-2015). Administrative regions were classified as conflict-affected or conflict-insulated based on the spatio-temporal frequency of conflict-related fatalities. Using a propensity score matching (PSM) approach, we estimated the association between conflict exposure and stunting (height-for-age Z-score < -2 SD) among a sample of 3,792 children matched on the basis of various demographic, socioeconomic and environmental attributes using the Average Treatment Effect on the Treated (ATT). Robustness checks across alternative matching algorithms and covariate exposure classification were carried out as well as sensitivity analysis for unmeasured confounding.
Results: The estimated ATT was 0.045 (95% bootstrap CI: 0.005-0.083), corresponding to a 4.5 percentage point higher prevalence of stunting among children residing in conflict-affected regions…
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