Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-26T11:48:06.440Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  08 April 2013

Benjamin Coghlan ,
Pascal Ngoy ,
Flavien Mulumba ,
Colleen Hardy ,
Valerie Nkamgang Bemo ,
Tony Stewart ,
Jennifer Lewis  and
Richard J. Brennan
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The humanitarian crisis in the Democratic Republic of Congo (DRC) has been among the world’s 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. (Disaster Med Public Health Preparedness. 2009;3:88–96)

Keywords

cluster surveysDemocratic Republic of Congomortalityconflictpostconflict
Type
Original Research and Critical Analysis
Information
Disaster Medicine and Public Health Preparedness , Volume 3 , Issue 2 , June 2009 , pp. 88 - 96
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Roberts, L.Mortality in Eastern DRC: Results From 5 Mortality Surveys. New York: International Rescue Committee; 2000.Google Scholar
2.Roberts, L, Belyadoumi, F, Cobey, L, et alMortality in the Eastern Democratic Republic of Congo: Results From 11 Mortality Surveys. New York: International Rescue Committee; 2001.Google Scholar
3.Roberts, L, Ngoy, P, Mone, C, et alMortality in the Democratic Republic of Congo: Results From a Nationwide Survey. New York: International Rescue Committee; 2002.Google Scholar
4.Roberts, L, Zantop, M.Elevated mortality associated with armed conflict—Democratic Republic of Congo, 2002. MMWR Morb Mort Wkly Report. 2003;52:469–471.Google Scholar
5.Coghlan, B, Brennan, RJ, Ngoy, P, et alMortality in the Democratic Republic of Congo: a nationwide survey. Lancet. 2006;367:44–51.Google Scholar
6. Departement du Plan. Direction des Etudes Macroeconomiques. Population and development in the Republic of Zaire: policies and programs. http://www.popline.org/docs/1440/037960.html. Accessed July 2, 2008.Google Scholar
7.Democratic Republic of Congo: Humanitarian Action Plan. New York: United Nations Office for the Coordination of Humanitarian Affairs; 2007.Google Scholar
8. State of the World’s Children Report 2007.New York: UNICEF; 2006.Google Scholar
9. Ministry of Health, Democratic Republic of Congo. Direction d’Etude et de Planification. http://www.minisanterdc.cd/leministere/diretudeetplanif.htm. Accessed April 2007.Google Scholar
10. World Health Organization, Expanded Programme on Immunization.Geneva: WHO; 1991.Google Scholar
11.Checchi, F, Roberts, L.Interpreting and Using Mortality Data in Humanitarian Emergencies: A Primer for Non-epidemiologists. Humanitarian Practice Network—Network Paper No. 52. London: Overseas Development Institute; 2005.Google Scholar
12. Minimum standards in health services. In: The Sphere Project: Humanitarian Charter and Minimum Standards in Disaster Response. Oxford, UK: Oxfam Publishing; 2004.Google Scholar
13. International Crisis Group. Katanga: The Congo’s Forgotten Crisis. Africa Report No. 103. Brussels. January 9, 2006. http://www.crisisgroup.org/home/index.cfm?id=3861&l=1. Accesssed October 25, 2007.Google Scholar
14.United Nations High Commissioner for Refugees. Handbook for Emergencies. 2nd ed. Geneva: UNHCR; 2000.Google Scholar
15. International Crisis Group. Congo: Consolidating the Peace. Africa report No. 128; 2007.Google Scholar
16. Tschoegl E, Degomme O, Guha-Sapir D. The Democratic Republic of Congo: a brief analysis of anthropometric surveys from 2000–2006. Centre for Epidemiology of Disasters Web site. http://www.cedat.be/sites/default/files/Brief%20Analysis%20of%20the%20DRC.pdf. Accessed January 8, 2007.Google Scholar
17. Medecins Sans Frontieres. Access to healthcare in post-war Sierra Leone. Summary of a 2005 survey in 4 districts: Kambia, Tonkolili, Bombali, Bo. MSF-Holland and MSF-Belgium. January 2006. http://artszondergrenzen.nl/usermedia/files/Sierra_Leone_survey_2006_summary.pdf. Accessed October 2, 2007.Google Scholar
18. Sapir DG, Gomez VT. Angola: The human impact of war. A data review of field surveys in Angola between 1999 and 2005. Centre for Epidemiology of Disasters Web site. http://reliefweb.int/rw/rwb.nsf/db900sid/PANA-7DZDB3?OpenDocument. Accessed April 14, 2009.Google Scholar
19. Centre for the Research on the Epidemiology of Disasters. Complex Emergency Database (CE-DAT). http://www.cedat.be/CEDAT/search/advsearch.php. Accessed October 25, 2007.Google Scholar
20.Ghobarah, HA, Russett Huth, P.The post-war public health effects of civil conflict. Soc Sci Med. 2004;59:869–884.Google Scholar
21.World Health Organization. World Health Statistics 2008. Geneva: WHO; 2008.Google Scholar
22. Brennan R, Husarska A. Inside Congo, an unspeakable toll. Washington Post. July 16, 2006:B3.Google Scholar
23. Prendergast J, Thomas-Jensen C. Averting the nightmare scenario in eastern Congo. Enough Strategy Paper No. 7. September 2007. http://www.enoughproject.org/publications/averting-nightmare-scenario-eastern-congo-activist-brief. Accessed April 14, 2009.Google Scholar
24.Rose, AMC, Grais, RF, Coulombier, D, et alA comparison of cluster and systematic sampling methods for measuring crude mortality. Bull WHO. 2006;84:290–296.Google Scholar
25.Working Group for Mortality Estimation in Emergencies. Wanted: studies on mortality estimation methods for humanitarian emergencies, suggestions for future research. Emerg Themes Epidemiol. 2007;4:9.Google Scholar
26.Spiegel, PB, Salama, P.War and mortality in Kosovo, 1998–99: an epidemiological testimony. Lancet. 2000;355:2204–2209.Google Scholar
27.Depoortere, E, Checchi, F, Broillet, F, et alViolence and mortality in West Darfur, Sudan (2003–04): epidemiological evidence from 4 surveys. Lancet. 2004;364:1315–1320.Google Scholar
28.Grais, RF, Rose, AMC, Guthmann, JP.Don’t spin the pen: 2 alternative methods for second-stage sampling in urban cluster surveys. Emerg Themes Epidemiol. 2007;4:8.Google Scholar