RESEARCH REPORT

Population-based survey methods to quantify associations between human rights violations and health outcomes among internally displaced persons in eastern Burma

Luke C Mullany¹, Adam K Richards², Catherine I Lee³, Voravit Suwanvanichkij¹, Cynthia Maung⁴, Mahn Mahn⁴, Chris Beyrer¹, Thomas J Lee³

¹ Center for Public Health and Human Rights, Bloomberg School of Public Health, Baltimore, MD, USA
² Department of Family & Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
³ Global Health Access Program, Mae Sot, Tak, Thailand
⁴ Backpack Health Worker Team, Mae Sot, Tak, Thailand

Correspondence to:
Dr Luke C Mullany, Assistant Professor, Center for Public Health and Human Rights, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, #E8646, Baltimore, MD 21205, USA; lmullany{at}jhsph.edu

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.

Keywords: Burma; mortality; human rights; internally displaced persons; malaria; landmines; civil conflict

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