title: Health and human rights in eastern Myanmar after the political transition: a population-based assessment using multistaged household cluster sampling.
abstract: BACKGROUND
  Myanmar transitioned to a nominally civilian parliamentary government in March 2011. Qualitative reports suggest that exposure to violence and displacement has declined while international assistance for health services has increased. An assessment of the impact of these changes on the health and human rights situation has not been published.
  
  
  RESULTS
  Five community-based organizations conducted household surveys using two-stage cluster sampling in five states in eastern Myanmar from July 2013-September 2013. Data was collected from 6, 178 households on demographics, mortality, health outcomes, water and sanitation, food security and nutrition, malaria, and human rights violations (HRV). Among children aged 6-59 months screened, the prevalence of global acute malnutrition (representing moderate or severe malnutrition) was 11.3% (8.0-14.7). A total of 250 deaths occurred during the year prior to the survey. Infant deaths accounted for 64 of these (IMR 94.2; 95% CI 66.5-133.5) and there were 94 child deaths (U5MR 141.9; 95% CI 94.8-189.0). 10.7% of households (95% CI 7.0-14.5) experienced at least one HRV in the past year, while four percent reported 2 or more HRVs. Household exposure to one or more HRVs was associated with moderate-severe malnutrition among children (14.9 vs. 6.8%; prevalence ratio 2.2, 95% CI 1.2-4.2). Household exposure to HRVs was associated with self-reported fair or poor health status among respondents (PR 1.3; 95% CI 1.1-1.5).
  
  
  CONCLUSIONS
  This large survey of health and human rights demonstrates that two years after political transition, vulnerable populations of eastern Myanmar are less likely to experience human rights violations compared to previous surveys. However, access to health services remains constrained, and risk of disease and death remains higher than the country as a whole. Efforts to address these poor health indicators should prioritize support for populations that remain outside the scope of most formal government and donor programs.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, 02118, United States of America.
authors.forename: Parveen Kaur
authors.initials: PK
authors.lastname: Parmar
authors.affiliation: Community Partners International, Mae Sot, Thailand; University of Washington, Seattle, Washington, United States of America.
authors.forename: Charlene C
authors.initials: CC
authors.lastname: Barina
authors.affiliation: Community Partners International, Mae Sot, Thailand.
authors.forename: Sharon
authors.initials: S
authors.lastname: Low
authors.affiliation: Community Partners International, Mae Sot, Thailand.
authors.forename: Kyaw Thura
authors.initials: KT
authors.lastname: Tun
authors.affiliation: Community Partners International, Mae Sot, Thailand.
authors.forename: Conrad
authors.initials: C
authors.lastname: Otterness
authors.affiliation: Burma Medical Association (BMA), Mae Sot, Thailand; Health Information Systems Information Group (HISWG), Mae Sot, Thailand.
authors.forename: Pue P
authors.initials: PP
authors.lastname: Mhote
authors.affiliation: Burma Medical Association (BMA), Mae Sot, Thailand.
authors.forename: Saw Nay
authors.initials: SN
authors.lastname: Htoo
authors.affiliation: Back Pack Health Worker Team, Mae Sot, Thailand.
authors.forename: Saw Win
authors.initials: SW
authors.lastname: Kyaw
authors.affiliation: Burma Medical Association (BMA), Mae Sot, Thailand; Back Pack Health Worker Team, Mae Sot, Thailand; Mae Tao Clinic, Mae Sot, Thailand.
authors.forename: Nai Aye
authors.initials: NA
authors.lastname: Lwin
authors.affiliation: Burma Medical Association (BMA), Mae Sot, Thailand; Back Pack Health Worker Team, Mae Sot, Thailand; Mae Tao Clinic, Mae Sot, Thailand.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Maung
authors.affiliation: Karen Department of Health and Welfare, Mae Sot, Thailand; Health Information Systems Information Group (HISWG), Mae Sot, Thailand.
authors.forename: Naw Merry
authors.initials: NM
authors.lastname: Moo
authors.affiliation: Karen Department of Health and Welfare, Mae Sot, Thailand.
authors.forename: Eh Kalu Shwe
authors.initials: EK
authors.lastname: Oo
authors.affiliation: Karenni Mobile Health Committee (KnMHC), Mae Hong Son, Thailand.
authors.forename: Daniel
authors.initials: D
authors.lastname: Reh
authors.affiliation: Mon National Health Committee (MNHC), Sangkhlaburi, Thailand.
authors.forename: Nai Chay
authors.initials: NC
authors.lastname: Mon
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Nakul
authors.initials: N
authors.lastname: Singh
authors.affiliation: Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Ravi
authors.initials: R
authors.lastname: Goyal
authors.affiliation: Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California, United States of America; Community Partners International, Berkeley, California, United States of America.
authors.forename: Adam K
authors.initials: AK
authors.lastname: Richards
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D046688:Child Mortality; D015362:Child Nutrition Disorders / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D005523:Food Supply; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006306:Health Surveys; D006806:Human Rights / Q000523:psychology*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D002052:Myanmar / Q000453:epidemiology; D009752:Nutritional Status; D014754:Violence / Q000706:statistics & numerical data; D035862:Vulnerable Populations / Q000523:psychology*