Population-based survey methods to quantify associations between human rights violations and health outcomes among internally displaced persons in eastern Burma.
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.
Mullany
Luke C
LC
Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA. lmullany@jhsph.edu
Richards
Adam K
AK
Lee
Catherine I
CI
Suwanvanichkij
Voravit
V
Maung
Cynthia
C
Mahn
Mahn
M
Beyrer
Chris
C
Lee
Thomas J
TJ
D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000453:epidemiology; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006806:Human Rights; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008875:Middle Aged; D002052:Myanmar / Q000453:epidemiology; D011156:Population Density; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014857:Warfare