Journal Article

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

Mahn, Mahn, Maung, Cynthia, Beyrer, Chris, Lee, Catherine I, Suwanvanichkij, Voravit, Lee, Thomas J, Richards, Adam K, Mullany, Luke C

2007

Overview

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.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group,BMJ,BMJ Publishing Group LTD,BMJ Group
• Subject: Adolescent / Adult / Advocacy / Biological and medical sciences / Blast Injuries - epidemiology / Burma / Child / Child Mortality / Child nutrition disorders / Child, Preschool / civil conflict / Criminal investigations / Data collection / Death / Displaced persons / Female / Food supply / Forced labor / General aspects / Health outcomes / Health risks / Health Status / Health Surveys / Households / Human Rights / Human rights violations / Humans / Infant / Infant Mortality / Infant, Newborn / internally displaced persons / Land mines / landmines / Malaria / Malaria, Falciparum - epidemiology / Male / Malnutrition / Malnutrition - epidemiology / Medical sciences / Methods / Middle Aged / Miscellaneous / Morbidity / Mortality / Mortality risk / Myanmar - epidemiology / Population Density / Public health / Public health. Hygiene / Public health. Hygiene-occupational medicine / Refugees - statistics & numerical data / Research Report / RESEARCH REPORTS / Retrospective Studies / Towns / Tribunals & commissions / Vector-borne diseases / Violations / Warfare