Five years after Congo’s devastating war “ended”, the country’s death rate remains the same. These are the findings of a survey released in mid January. The study estimates 45,000 die every month in the Congo, the same numbers as revealed by a wartime survey in 2004.
Still, improvements in security since 2004, when the last survey was completed, meant that researchers were able to visit many areas that were off limits last time, and as a result, its authors said, the current survey provides the most complete picture yet of the toll of Congo’s slide into despair.
That picture is not encouraging. The survey found that the mortality rate in Congo is 57 percent higher than in the rest of sub-Saharan Africa. Particularly hard hit were young children, who are especially susceptible to diseases like malaria, measles, dysentery and typhoid, serious killers in the absence of medicine. In one village in North Kivu Province, a hot spot of continued fighting, three women of the 20 households surveyed had lost two children each in the 16 months covered by the survey period, Dr. Brennan said.
Less than half a percentage point of the deaths were caused by violence, illustrating how the aftermath of war can be more deadly than combat itself. Much of the emergency aid is focused on the eastern part of the country, where militia battles with Congolese troops have chased nearly half a million people from their homes in the last year. A peace agreement to end that conflict was reached Monday.
Hat Tip: PCR Project
Always a sucker for a good war and health related graphic, I can’t help but post about Nightingale’s Rose. The Rose is a graphical representation of William Farr’s mortality data on the Crimean War, drawn by the one and only Florence Nightingale. The chart visualizes infectious disease (in blue), battle casualties (in red), and other deaths (in black) .
While interesting, the Nightingale Rose is, for three reasons, far from my favorite visualization of casualty data. First, the wedges are measured from the center (and therefore overlap), however this is not intuitively derived from the graphic itself and thus can easily lead to misinterpretation. Second, as with pie charts, I find it difficult to accurately compare wedges of similar size. Take, for example, the August 1984 and November 1984 blue wedges. Which is larger? Third, the area of each wedge represents its numerical value, however, since this is accomplished by increases the radius of the wedge, the representation takes on an exponential property. For instance, a wedge representing twice as many deaths as another wedge would not have twice the radius. Again, this takes away from the intuitive interpretation of the graphic. Not to say it isn’t still very cool.
This graphic is republished with permission from its creator, Hugh Small.
On January 9th a new Iraq War mortality study was released by the New England Journal of Medicine. This study represents the third major attempt to count Iraqi deaths since the start of the war. Iraq Body Count was the first attempt, counting the number of deaths published in news reports. The operators of Iraq Body Count freely admit the real number is likely much higher and that their value (47,668) represents at best a minimum value. The second attempt was the now infamous “Lancet” and “Lancet II” studies whose validity was blasted this week in a National Journal article (good read). The last of the Lancet survey-based studies found 601,027 Iraqi deaths since 2003. The National Journal article eloquently puts the magnitude of that number into perspective:
“The February 2006 bombing of the Golden Mosque is widely credited with plunging Iraq into civil war, yet the Lancet II report posits the equivalent of five to 10 bombings of this magnitude in Iraq every day for three years.”
This latest study from the Iraq Family Health Survey Study Group is based off 9345 household surveys and estimated 151,000 violent deaths from March 2003 through June 2006:
Interviewers visited 89.4% of 1086 household clusters during the study period; the household response rate was 96.2%. From January 2002 through June 2006, there were 1325 reported deaths. After adjustment for missing clusters, the overall rate of death per 1000 person-years was 5.31 (95% confidence interval [CI], 4.89 to 5.77); the estimated rate of violence-related death was 1.09 (95% CI, 0.81 to 1.50). When underreporting was taken into account, the rate of violence-related death was estimated to be 1.67 (95% uncertainty range, 1.24 to 2.30). This rate translates into an estimated number of violent deaths of 151,000 (95% uncertainty range, 104,000 to 223,000) from March 2003 through June 2006.
One finding which is consistent across all three studies is that violence was a leading cause of death amongst Iraqi adults. This is contrary to what we find in wars historically. Infectious disease typically far outnumbers violent deaths. This historic discrepancy might be caused by Iraq’s relatively (compared to previous wars and even the modern states) high levels of pre-war education and quality healthcare.