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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?