Richard J Brennan

Mortality in the Democratic Republic of Congo: a nationwide survey

BACKGROUND Commencing in 1998, the war in the Democratic Republic of Congo has been a humanitarian disaster, but has drawn little response from the international community. To document rates and trends in mortality and provide recommendations for political and humanitarian interventions, we did a nationwide mortality survey during April-July, 2004. METHODS We used a stratified three-stage, household-based cluster sampling technique. Of 511 health zones, 49 were excluded because of insecurity, and four were purposely selected to allow historical comparisons. From the remainder, probability of selection was proportional to population size. Geographical distribution and size of cluster determined how households were selected: systematic random or classic proximity sampling. Heads of households were asked about all deaths of household members during January, 2003, to April, 2004. FINDINGS 19,500 households were visited. The national crude mortality rate of 2.1 deaths per 1000 per month (95% CI 1.6-2.6) was 40% higher than the sub-Saharan regional level (1.5), corresponding to 600,000 more deaths than would be expected during the recall period and 38,000 excess deaths per month. Total death toll from the conflict (1998-2004) was estimated to be 3.9 million. Mortality rate was higher in unstable eastern provinces, showing the effect of insecurity. Most deaths were from easily preventable and treatable illnesses rather than violence. Regression analysis suggested that if the effects of violence were removed, all-cause mortality could fall to almost normal rates. INTERPRETATION The conflict in the Democratic Republic of Congo remains the worlds deadliest humanitarian crisis. To save lives, improvements in security and increased humanitarian assistance are urgently needed.

Rapid health assessment in Aceh Jaya District, Indonesia, following the December 26 tsunami.

Objectives:  To rapidly determine the public health impact of the Asian tsunami on the population of three communities in Aceh Jaya District, Indonesia, and to prioritize health interventions.

Update on Mortality in the Democratic Republic of Congo: Results From a Third Nationwide Survey

BACKGROUND The humanitarian crisis in the Democratic Republic of Congo (DRC) has been among the worlds deadliest in recent decades. We conducted our third nationwide survey to examine trends in mortality rates during a period of changing political, security, and humanitarian conditions. METHODS We used a 3-stage, household-based cluster sampling technique to compare east and west DRC. Sixteen east health zones and 15 west zones were selected with a probability proportional to population size. Four east zones were purposely selected to allow historical comparisons. The 20 smallest population units were sampled in each zone, 20 households in each unit. The number and distribution of households determined whether they were selected using systematic random or random walk sampling. Respondents were asked about deaths of household members during the recall period: January 2006-April 2007. FINDINGS In all, 14,000 households were visited. The national crude mortality rate of 2.2 deaths per 1000 population per month (95% confidence interval [CI] 2.1-2.3) is almost 70% higher than that documented for DRC in the 1984 census (1.3) and is unchanged since 2004. A small but significant decrease in mortality since 2004 in the insecure east (rate ratio: 0.96, P = .026) was offset by increases in the western provinces and a transition area in the center of the country. Nonetheless, the crude mortality rate in the insecure east (2.6) remains significantly higher than in the other regions (2.0 and 2.1, respectively). Deaths from violence have declined since 2004 (rate ratio 0.7, P = .02). CONCLUSIONS More than 4 years after the official end of war, the crude mortality rate remains elevated across DRC. Slight but significant improvements in mortality in the insecure east coincided temporally with recent progress on security, humanitarian, and political fronts.

Challenges and Opportunities for Humanitarian Relief in Afghanistan

Afghanistan is in the midst of a profound humanitarian crisis resulting primarily from long-standing armed conflict, a devastating drought, and massive population migration. The economy, government, and health care system are in shambles. Currently, as many as 5 million Afghans are in camps either as refugees in neighboring countries or as internally displaced persons within Afghanistan. Much of the rest of the population is in dire need of basic essentials such as food, water, shelter, and basic medical care. Those attempting to carry out humanitarian relief face many daunting challenges, such as reaching remote locations, coping with a dangerous security situation, and working with limited resources. However, there are opportunities in the short run to save many lives and substantially improve the plight of Afghans by carrying out appropriate and effective emergency relief programs. Over the long term, effective medical and public health relief efforts will be an essential part of rehabilitating and rebuilding this devastated country.

Rehabilitating Public Health Infrastructure in the Post-Conflict Setting: Epidemic Prevention and Preparedness in Kosovo

The war in Kosovo in 1999 resulted in the displacement of up to 1.5 million persons from their homes. On the subsequent return of the refugees and internally displaced persons, one of the major challenges facing the local population and the international community, was the rehabilitation of Kosovos public health infrastructure, which had sustained enormous damage as a result of the fighting. Of particular importance was the need to develop a system of epidemic prevention and preparedness. But no single agency had the resources or capacity to implement such a program. Therefore, a unique six-point model was developed as a collaboration between the Kosovo Institute of Public Health, the World Health Organization, and an international, non-governmental organization. Important components of the program included a major Kosovo-wide baseline health survey, the development of a province-wide public health surveillance system, rehabilitation of microbiology laboratories, and the development of a local capacity for epidemic response. While all program objectives were met, important lessons were learned concerning the planning, design, and implementation of such a project. This program represents a model that potentially could be replicated in other post-conflict or development settings.

Aeromedical Triage Support to Mass-Casualty Events

Triage officers have an opportunity to contribute greatly to the effective management of mass-casualty events, transforming the casualties to patients as they move from the disaster to a hospital bed. The factors unique to aeromedical triage support are critical to overall mass-casualty triage, evacuation, and management. Advanced technologies such as telemedicine/telecommunications have the potential of augmenting aeromedical triage decision making from great distances.