Table 2. Adjusted DID Estimation of Associations Between Conflict Severity and Key Health Systems Indicatorsa.
| DID Estimator by Conflict Intensity × Timeb | 2004-2010 | 2011-2016 | ||
|---|---|---|---|---|
| β Coefficient (95% CI) | P Value | β Coefficient (95% CI) | P Value | |
| Equipment functionality index | ||||
| Moderate-intensity conflict × time | –3.3 (–5.1 to –1.5) | <.001 | 0.1 (–0.4 to 0.6) | .59 |
| Severe-intensity conflict × time | –12.4 (–21.4 to –3.4) | .01 | –0.4 (–0.9 to 0.1) | .11 |
| Drug availability index | ||||
| Moderate-intensity conflict × time | 0.2 (–2.8 to –3.1) | .90 | NA | NA |
| Severe-intensity conflict × time | 13.8 (–1.0 to 28.6) | .07 | NA | NA |
| Pharmaceuticals and vaccines availability index | ||||
| Moderate-intensity conflict × time | NA | NA | 1.9 (1.3 to 2.4) | <.001 |
| Severe-intensity conflict × time | NA | NA | 1.5 (0.9 to 2.0) | <.001 |
| Infrastructure index | ||||
| Moderate-intensity conflict × time | –2.3 (–4.8 to 0.2) | .08 | NA | NA |
| Severe-intensity conflict × time | 7.0 (–5.4 to 19.4) | .27 | NA | NA |
| Functional infrastructure index | ||||
| Moderate-intensity conflict × time | NA | NA | –0.4 (–1.2 to 0.5) | .41 |
| Severe-intensity conflict × time | NA | NA | –1.6 (–2.4 to –0.8) | <.001 |
| Patient history and physical examination index | ||||
| Moderate-intensity conflict × time | –1.0 (–0.8 to 2.7) | .27 | NA | NA |
| Severe-intensity conflict × time | –4.0 (–12.8 to 4.8) | .37 | NA | NA |
| Client background and physical assessment index | ||||
| Moderate-intensity conflict × time | NA | NA | 0.4 (–0.2 to 0.9) | .18 |
| Severe-intensity conflict × time | NA | NA | –1.0 (–1.5 to –0.5) | <.001 |
| Patient counseling index | ||||
| Moderate-intensity conflict × time | –0.9 (–3.4 to –1.6) | .47 | NA | NA |
| Severe-intensity conflict × time | 6.9 (–5.8 to –19.5) | .29 | NA | NA |
| Client counseling index | ||||
| Moderate-intensity conflict × time | NA | NA | 2.2 (1.4 to 3.1) | <.001 |
| Severe-intensity conflict × time | NA | NA | 0.1 (–0.7 to 0.9) | .73 |
| Female health worker index | ||||
| Moderate-intensity conflict × time | NA | NA | 0.4 (–0.3 to 1.1) | .23 |
| Severe-intensity conflict × time | NA | NA | 0.2 (–0.4 to 0.8) | .48 |
| Health care professional knowledge score | ||||
| Moderate-intensity conflict × time | NA | NA | 1.0 (0.3 to 1.6) | .003 |
| Severe-intensity conflict × time | NA | NA | 1.2 (0.6 to 1.8) | <.001 |
Abbreviations: DID, difference-in-difference; NA, not available.
a
Models are adjusted for the main effects of conflict and time and covariates including patient volume, facility type, geographic region, and contracting type; complete results are given in eFigure 5 and eTable 10 in the Supplement.
b
Time is a binary indicator for the years at the beginning and end of each period. The interaction term indicates whether the change in the covariate was associated with a change in the outcome over time. Minimal-intensity conflict × time is the reference category.