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Mortality surveysMortality surveysin conflict and post conflict Angolain conflict and post conflict Angola

1990 - 20061990 - 2006  

Sibylle Gerstl, Harold Noël, Vincent Brown

Epicentre, Paris, France

HistoryHistory 1974

2002 2006

1975

end of colonialism

civil war

April 6: cease-fire agreement

signed

great potential fordevelopment (oil,

diamonds)

Consequences of the warConsequences of the war 2002 200

61975

civil war

500 000 people killed Thousands of people internally displaced

Resettlement areas Landmines Ranked 161/177 on the

Human Development Index

cease-fire agreement

MSF in AngolaMSF in Angola 2002 200

61975

MSF in Angola

1982

20021975

1982

MSF in AngolaMSF in Angola2006

1990

9 surveysEpicentre/M

SF

200

61990

9 surveys Epicentre/MSF

Surveys Epicentre / MSF in Surveys Epicentre / MSF in AngolaAngola 200

0

3 during civil war

2002

5 in resettlement areas justafter the war

1 in rural area post - war

Democratic Republic of the Congo

Zambia

Namibia

ANGOLA

Geographical distribution of Geographical distribution of surveyssurveys

Malanje (2000)

During civil During civil warwar

Kuito (2000)Cubal (1999)

After the After the warwarCamacupa (2002)Bailundo (2002)

Bunjei (2002)

Bie (2002)Mavinga (2002)

Xa-Muteba (2006)

Post - warPost - war

Survey methodology Survey methodology Two-stage cluster sampling 30 clusters x 30 households Standardized questionnaire Recall period 2 – 14 months

CMR (crude mortality rate) U5MR (under five mortality rate)

Reported causes of death

Deaths / 10 000 / dayDeaths / 10 000 / day

123

4789

10

CMRU5MR

during civil war

just after war

post - war

0

10

20

30

40

50

60

70

80

post - war

0

10

20

30

40

50

60

70

80

just after war

Main causes of deathMain causes of deathViolence

Malnutrition

Infectious diseases

0

10

20

30

40

50

60

70

80

during civil war

[%]

A closer look at the post-war A closer look at the post-war surveysurveyXa-Muteba, 2006 Xa-Muteba, 2006 85.4% (41/48) died at home 10 deaths were ≤ 1 month (10/48) Fever / Malaria leading cause of death

Total: 37.5% (18/48) < 5 years: 51.6% (16/31)

MSF will close Xa-Muteba, July 2007

DiscussionDiscussionThe health emergency continues evenafter war and displacement subside CMR and U5MR remain unacceptably high Typical pattern of infectious diseases

Did these surveys have an impact for the health of these populations?How do we use mortality surveys to focus attention on post-war health crises?Do we really even understand post-war health crises?WHAT

NOW?