IJE Advance Access originally published online on December 2, 2005
International Journal of Epidemiology 2006 35(2):438-446; doi:10.1093/ije/dyi246
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Mortality patterns during a war in Guinea-Bissau 1998–99: changes in risk factors?
1 Bandim Health Project, Guinea-Bissau, West Africa
2 Danish Epidemiology Science Centre, Statens Serum Institut, Denmark
3 Department of Biostatistics, University of Copenhagen, Denmark
* Corresponding author. Bandim Health Project, Danish Epidemiology Science Centre, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark. E-mail: nls{at}ssi.dk
Background The crude mortality rate of the whole population and the mortality of children <5 years of age are the common indicators of the severity of a complex emergency situation. However, these indicators rarely take account of differences in socioeconomic conditions and vulnerability.
Methods We followed a population in Guinea-Bissau, which fled when fighting took place in the capital during the war in 1998–99. The population stayed close to the area of conflict and returned as soon as a cease-fire was negotiated. A peace treaty was signed after half-a-year. The following 6 months was a period of returning and re-settlement, even though two outbreaks of fighting occurred.
Results In the first half-year the mortality rate was 78% [mortality ratio (MR) = 1.78; 95% CI 1.61–1.97] increased and mortality for children <5 years of age doubled (MR = 2.07; 95% CI 1.79–2.38). In the last 6 months of the war, mortality was slightly increased for children and not at all for the total population. In the first half-year, households living in better houses and having members with schooling were less affected. In the ‘re-settlement’ period two inequalities emerged; the largest ethnic group, Pepel, continued to have high mortality when the mortality of other groups declined; likewise girls continued to have an elevated mortality whereas mortality of boys declined.
Conclusion Whereas specific ‘free’ interventions reduced social inequalities for the groups affected, for the total population health-inequalities were slightly amplified during the war. Once the population returned to their urban homes, mortality fell to pre-war levels even though some fighting continued, limited humanitarian aid was available and the pre-war infra-structure had not been re-established.
Accepted 13 October 2005
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