Mullany Luke C, Richards Adam K, Lee Catherine I, Suwanvanichkij Voravit, Maung Cynthia, Mahn Mahn, Beyrer Chris, Lee Thomas J
Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
J Epidemiol Community Health. 2007 Oct;61(10):908-14. doi: 10.1136/jech.2006.055087.
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.
背景:关于侵犯人权行为的案例报告主要聚焦于个人经历。基于人群对权利指标与健康结果之间的关联进行量化的研究很少,且在缅甸东部尚无相关记录。 目的:我们描述了缅甸东部境内流离失所者的死亡率和发病率与家庭层面侵犯人权经历之间的关联。 方法:2004年,缅甸东部冲突地区的流动医护人员开展了1834次回顾性家庭调查。工作人员记录了重要事件、幼儿上臂中部周长、受访者的疟疾寄生虫血症状况以及过去12个月内家庭遭受各种侵犯人权行为的经历等数据。 结果:每1000例活产中5岁以下儿童死亡率为218例(95%置信区间为135至301)。近三分之一的家庭报告称遭受过强迫劳动(32.6%)。被迫流离失所(占家庭的8.9%)与儿童死亡率增加(比值比=2.80)、儿童营养不良(比值比=3.22)以及地雷伤害(比值比=3.89)相关。食物供应被盗或被毁(25.2%的家庭报告)与粗死亡率增加(比值比=1.58)、疟疾寄生虫血症(比值比=1.82)、儿童营养不良(比值比=1.94)以及地雷伤害(比值比=4.55)相关。多种权利侵犯行为(占家庭的14.4%)增加了儿童(发病率比=2.18)和粗死亡率(发病率比=1.75)以及地雷伤害的几率(比值比=19.8)。在报告有三种或更多权利侵犯行为的家庭中,儿童死亡风险增加了五倍多(发病率比=5.23)。 结论:缅甸东部冲突地区普遍存在的侵犯人权行为与发病率和死亡率显著增加相关。可以使用标准流行病学方法对人群层面的关联进行量化。这种方法需要在其他地方进一步验证和完善。
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