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Cited by 71Health and Conflict StudiesAsian Geopolitics and EthnographyPolitical Conflict and Governance

Population-based survey methods to quantify associations between human rights violations and health outcomes among internally displaced persons in eastern Burma.

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Mullany, Luke C, Richards, Adam K, Lee, Catherine I, Suwanvanichkij, Voravit, Maung, Cynthia, Mahn, Mahn, Beyrer, Chris, Lee, Thomas J·2007·Journal of Epidemiology and Community Health
DOI 10.1136/jech.2006.055087PMC PMC2652972
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Abstract

Background: Case reports of human rights violations have focused on individuals’ experiences. Population-based quantification of associations between rights indicators and health outcomes is rare and has not been documented in eastern Burma. Objective: We describe the association between mortality and morbidity and the household-level experience of human rights violations among internally displaced persons in eastern Burma. Methods: Mobile health workers in conflict zones of eastern Burma conducted 1834 retrospective household surveys in 2004. Workers recorded data on vital events, mid-upper arm circumference of young children, malaria parasitaemia status of respondents and household experience of various human rights violations during the previous 12 months. Results: Under-5 mortality was 218 (95% confidence interval 135 to 301) per 1000 live births. Almost one-third of households reported forced labour (32.6%). Forced displacement (8.9% of households) was associated with increased child mortality (odds ratio = 2.80), child malnutrition (odds ratio = 3.22) and landmine injury (odds ratio = 3.89). Theft or destruction of the food supply (reported by 25.2% of households) was associated with increased crude mortality (odds ratio = 1.58), malaria parasitaemia (odds ratio = 1.82), child malnutrition (odds ratio = 1.94) and landmine injury (odds ratio = 4.55). Multiple rights violations (14.4% of households) increased the risk of child (incidence rate ratio = 2.18) and crude (incidence rate ratio = 1.75) mortality and the odds of landmine injury (odds ratio = 19.8). Child mortality risk was increased more than fivefold (incidence rate ratio = 5.23) among families reporting three or more rights violations. Conclusions: Widespread human rights violations in conflict zones in eastern Burma are associated with significantly increased morbidity and mortality. Population-level associations can be quantified using standard epidemiological methods. This approach requires further validation and refinement elsewhere.

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  • The stillbirth rate may well be under-estimated.

    “SMRU implemented the WHO partogram in 1994 and while the stillbirth rate of 12.1 (95%CI 11.1-31.2) per 1000 total births is at the global target, like maternal mortality it may well be under-estimated 35 .”

    From A mixed methods evaluation of Advanced Life Support in Obstetrics (ALSO) and Basic Life Support in Obstetrics (BLSO) in a resource-limited setting on the Thailand-Myanmar border (2021) · cites this paper as [35]

    The Mortality rates and morbidity section reports live births and infant and child deaths, but does not report a stillbirth rate. The Discussion notes that recall can bias mortality surveys, without saying that stillbirths—or the SMRU rate—were underestimated. Searches for stillbirth, maternal mortality, and underestimation found no passage addressing the claim. (LLM, conf=0.77)

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Authors
Mullany, L. C., Richards, A. K., Lee, C. I., Suwanvanichkij, V., Maung, C., Mahn, M., Beyrer, C., & Lee, T. J.
Affiliations
  • Johns Hopkins University (US)
  • Albert Einstein College of Medicine (US)
Corresponding author
Mullany, Luke C
ORCID
Venue
Journal of Epidemiology and Community Health
Publisher
BMJ
Published
2007-09-14
Volume
61
Issue
10
Pages
908-914
ISSN
  • 0141-7681 (ISSN-L)
  • 0143-005X
  • 1470-2738
DOI
10.1136/jech.2006.055087
PMC
PMC2652972
OpenAlex
W2075473548
Cited by
71
References
42
Citations by year
2024: 1 · 2023: 2 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 6 · 2018: 4 · 2017: 5 · 2016: 5 · 2015: 6 · 2014: 6 · 2013: 5 · 2012: 3
FWCI
9.87
Type
journal article
Language
en
Open access
Locations
  • Journal of Epidemiology & Community Health (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
  • Social Sciences › Political Science and International Relations › Asian Geopolitics and Ethnography
  • Social Sciences › Sociology and Political Science › Political Conflict and Governance
Keywords
human rights violations, internally displaced persons, armed conflict, child mortality, under-five mortality, child malnutrition, landmine injuries, malaria parasitaemia, forced labor, forced displacement
MeSH terms
Adolescent, Adult, Blast Injuries, Myanmar, Child, Child, Preschool, Female, Health Status, Health Surveys, Humans, Human Rights, Infant, Infant Mortality, Infant, Newborn, Male, Middle Aged, Population Density, Refugees, Retrospective Studies, Warfare, Malaria, Falciparum, Malnutrition, Child Mortality

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