This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ http://www.conflictandhealth.commostviewed/ Most viewed articles in last 30 days from Conflict and Health (ISSN 1752-1505) published by BioMed Central Background: The health system in Iraq has undergone progressive decline since the embargo that followed the second gulf war in 1991. The aim of this study is to see barriers to glycemic control form the patient perspective, in a diabetic clinic in the south of Iraq. Methods: A cross sectional study from the diabetes out-patient clinic in Al-Faiha general hospital in Basrah, South Iraq for the period from January to December 2007. The study includes diabetic patients whether type 1 or 2 if they have at least one year of follow up in the same clinic. Those with A1C ≥ 7% were interviewed by special questionnaire, that was filled in by the medical staff of the clinic. The subjects analyzed in this study were adults (≥ 18 years old) with previously diagnosed diabetes (n = 3522). The duration of diabetes range from 1 to 30 years. Results: Mean A1C was 8.4 ± 2 percent, with 835(23.7%) patients with A1C less than 7% and 2688(76.3%) equal to or more than 7%. Of 3522 studied patients, 46.6% were men and 51.5% were women, with mean age of 53.78 ± 12.81 year and age range 18–97 years. Patient opinion for not achieving good glycemic control among 2688 patients with HbA1C ≥ 7% included the following. No drug supply from primary health care center (PHC) or drug shortage is a cause in 50.8% of cases, while drugs and or laboratory expense were the cause in 50.2%. Thirty point seven percent of patients said that they were unaware of diabetics complications and 20.9% think that diabetes is an untreatable disease. Thirty percent think that non-control of their diabetes is due to migration after the war. No electricity or erratic electricity, self-monitoring of blood glucose (SMBG) is not available, or strips were not available or could not be used, and illiteracy as a cause was seen in 15%, 10.8% and 9.9% respectively. Conclusion: Our patients with diabetes mellitus declared that of the causes for poor glycemic control most of them related to the current health situation in Iraq. http://www.conflictandhealth.com/content/2/1/7 Abbas Ali Mansour Conflict and Health 2008, 2:7 Number of accesses: 350 2008-06-24 doi:10.1186/1752-1505-2-7 Conflict and Health 1752-1505 2 7 2008-06-24 Background: In March 2003, the United States invaded Iraq. The subsequent number, rates, and causes of mortality in Iraq resulting from the war remain unclear, despite intense international attention. Understanding mortality estimates from modern warfare, where the majority of casualties are civilian, is of critical importance for public health and protection afforded under international humanitarian law. We aimed to review the studies, reports and counts on Iraqi deaths since the start of the war and assessed their methodological quality and results. Methods: We performed a systematic search of 15 electronic databases from inception to January 2008. In addition, we conducted a non-structured search of 3 other databases, reviewed study reference lists and contacted subject matter experts. We included studies that provided estimates of Iraqi deaths based on primary research over a reported period of time since the invasion. We excluded studies that summarized mortality estimates and combined non-fatal injuries and also studies of specific sub-populations, e.g. under-5 mortality. We calculated crude and cause-specific mortality rates attributable to violence and average deaths per day for each study, where not already provided. Results: Thirteen studies met the eligibility criteria. The studies used a wide range of methodologies, varying from sentinel-data collection to population-based surveys. Studies assessed as the highest quality, those using population-based methods, yielded the highest estimates. Average deaths per day ranged from 48 to 759. The cause-specific mortality rates attributable to violence ranged from 0.64 to 10.25 per 1,000 per year. Conclusion: Our review indicates that, despite varying estimates, the mortality burden of the war and its sequelae on Iraq is large. The use of established epidemiological methods is rare. This review illustrates the pressing need to promote sound epidemiologic approaches to determining mortality estimates and to establish guidelines for policy-makers, the media and the public on how to interpret these estimates. http://www.conflictandhealth.com/content/2/1/1 Christine Tapp, Frederick M Burkle, Kumanan Wilson, Tim Takaro, Gordon H Guyatt, Hani Amad and Edward J Mills Conflict and Health 2008, 2:1 Number of accesses: 171 2008-03-07 doi:10.1186/1752-1505-2-1 Conflict and Health 1752-1505 2 1 2008-03-07 Background: Tobacco is a leading cause of death globally. There are limited reports on current cigarette smoking prevalence and its associated-antismoking messages among adolescents in conflict zones of the world. We, therefore, conducted secondary analysis of data to estimate the prevalence of current cigarette smoking, and to determine associations of antismoking messages with smoking status. Methods: We used data from the Somaliland Global Youth Tobacco Survey (GYTS) of 2004 to estimate the prevalence of smoking. We also assessed whether being exposed to anti-smoking media, education and having discussed with family members on the harmful effects of smoking were associated with smoking. Logistic regression analysis was used to assess these associations. Current smoking was defined as having reported smoking cigarettes, even a single puff, in the last 30 days preceding the survey (main outcome). Results: Altogether 1563 adolescents participated in the survey. However, 1122 had data on the main outcome. Altogether, 15.8% of the respondents reported having smoked cigarettes (10.3% among males, and 11.1% among females). Factors that were associated with reported non-smoking were: discussing harmful effects of smoking cigarettes with their family members (OR = 0.61, 95% CI 0.52, 0.71); being taught that smoking makes teeth yellow, causes wrinkles and smokers smell badly (OR = 0.62, 95% CI 0.52, 0.74); being taught that people of the respondent's age do not smoke (OR = 0.81, 95% CI 0.69, 0.95); and having reported that religious organizations discouraged young people smoking (OR = 0.70, 95% CI 0.60, 0.82). However, exposure to a lot many antismoking messages at social gatherings was associated with smoking. Exposure to antismoking print media was not associated with smoking status. Conclusion: A combination of school and home based antismoking interventions may be effective in controlling adolescent smoking in Somaliland. http://www.conflictandhealth.com/content/2/1/6 Seter Siziya, Emmanuel Rudatsikira and Adamson S Muula Conflict and Health 2008, 2:6 Number of accesses: 170 2008-05-23 doi:10.1186/1752-1505-2-6 Conflict and Health 1752-1505 2 6 2008-05-23 While unprotected sexual intercourse and the use of contaminated injection equipment account for the majority of HIV infections worldwide, other routes of HIV transmission have received less attention. We report on a case of HIV transmission attributable to illicit drug market violence involving a participant in a prospective cohort study of injection drug users. Data from a qualitative interview was used in addition to questionnaire data and nursing records to document an episode of violence which likely resulted in this individual acquiring HIV infection. The case report demonstrates that the dangers of drug market violence go beyond the immediate physical trauma associated with violent altercations to include the possibility for infectious disease transmission. The case highlights the need to consider antiretroviral post-exposure prophylaxis in cases of drug market violence presenting to the emergency room, as well strategies to reduce violence associated with street-based drug markets. http://www.conflictandhealth.com/content/2/1/8 Will Small, Thomas Kerr and Evan Wood Conflict and Health 2008, 2:8 Number of accesses: 159 2008-07-18 doi:10.1186/1752-1505-2-8 Conflict and Health 1752-1505 2 8 2008-07-18 Myanmar is experiencing an HIV epidemic documented since the late 1980s. The National AIDS Programme national surveillance ante-natal clinics had already estimated in 1993 that 1.4% of pregnant women were HIV positive, and UNAIDS estimates that at end 2005 1.3% (range 0.7–2.0%) of the adult population was living with HIV. While a HIV surveillance system has been in place since 1992, the programmatic response to the epidemic has been slower to emerge although short- and medium-terms plans have been formulated since 1990. These early plans focused on the health sector, omitted key population groups at risk of HIV transmission and have not been adequately funded. The public health system more generally is severely under-funded.By the beginning of the new decade, a number of organisations had begun working on HIV and AIDS, though not yet in a formally coordinated manner. The Joint Programme on AIDS in Myanmar 2003–2005 was an attempt to deliver HIV services through a planned and agreed strategic framework. Donors established the Fund for HIV/AIDS in Myanmar (FHAM), providing a pooled mechanism for funding and significantly increasing the resources available in Myanmar. By 2006 substantial advances had been made in terms of scope and diversity of service delivery, including outreach to most at risk populations to HIV. More organisations provided more services to an increased number of people. Services ranged from the provision of HIV prevention messages via mass media and through peers from high-risk groups, to the provision of care, treatment and support for people living with HIV. However, the data also show that this scaling up has not been sufficient to reach the vast majority of people in need of HIV and AIDS services.The operating environment constrains activities, but does not, in general, prohibit them. The slow rate of service expansion can be attributed to the burdens imposed by administrative measures, broader constraints on research, debate and organizing, and insufficient resources. Nevertheless, evidence of recent years illustrates that increased investment leads to more services provided to people in need, helping them to obtain their right to health care. But service expansion, policy improvement and capacity building cannot occur without more resources. http://www.conflictandhealth.com/content/2/1/3 Brian Williams, Daniel Baker, Markus Bühler and Charles Petrie Conflict and Health 2008, 2:3 Number of accesses: 151 2008-03-14 doi:10.1186/1752-1505-2-3 Conflict and Health 1752-1505 2 3 2008-03-14 Background: Mobile population groups are at high risk for contracting HIV infection. Many factors contribute to this risk including high prevalence of risky behavior and increased risk of violence due to conflict and war. The Naf River serves as the primary border crossing point between Teknaf, Bangladesh and Mynamar [Burma] for both official and unofficial travel of people and goods. Little is known about the risk behavior of boatmen who travel back and forth between Teknaf and Myanmar. However, we hypothesize that boatmen may act as a bridging population for HIV/AIDS between the high-prevalence country of Myanmar and the low-prevalence country of Bangladesh. Methods: Methods included initial rapport building with community members, mapping of boatmen communities, and in-depth qualitative interviews with key informants and members from other vulnerable groups such as spouses of boatmen, commercial female sex workers, and injecting drug users. Information from the first three stages was used to create a cross-sectional survey that was administered to 433 boatmen. Results: Over 40% of the boatmen had visited Myanmar during the course of their work. 17% of these boatmen had sex with CSW while abroad. There was a significant correlation found between the number of nights spent in Myanmar and sex with commercial sex workers.In the past year, 19% of all boatmen surveyed had sex with another man. 14% of boatmen had participated in group sex, with groups ranging in size from three to fourteen people. Condom use was rare {0 to 4.7% during the last month}, irrespective of types of sex partners. Regression analysis showed that boatmen who were 25 years and older were statistically less likely to have sexual intercourse with non- marital female partners in the last year compared to the boatmen aged less than 25 years. Similarly deep-sea fishing boatmen and non-fishing boatmen were statistically less likely to have sexual intercourse with non- marital female partners in the last year compared to the day long fishing boatmen adjusting for all other variables. Boatmen's knowledge regarding HIV transmission and personal risk perception for contracting HIV was low. Conclusion: Boatmen in Teknaf are an integral part of a high-risk sexual behaviour network between Myanmar and Bangladesh. They are at risk of obtaining HIV infection due to cross border mobility and unsafe sexual practices. There is an urgent need for designing interventions targeting boatmen in Teknaf to combat an impending epidemic of HIV among this group. They could be included in the serological surveillance as a vulnerable group. Interventions need to address issues on both sides of the border, other vulnerable groups, and refugees. Strong political will and cross border collaboration is mandatory for such interventions. http://www.conflictandhealth.com/content/2/1/5 Rukhsana Gazi, Alec Mercer, Tanyaporn Wansom, Humayun Kabir, Nirod Chandra Saha and Tasnim Azim Conflict and Health 2008, 2:5 Number of accesses: 142 2008-03-14 doi:10.1186/1752-1505-2-5 Conflict and Health 1752-1505 2 5 2008-03-14 Decades of neglect and abuses by the Burmese government have decimated the health of the peoples of Burma, particularly along her eastern frontiers, overwhelmingly populated by ethnic minorities such as the Shan. Vast areas of traditional Shan homelands have been systematically depopulated by the Burmese military regime as part of its counter-insurgency policy, which also employs widespread abuses of civilians by Burmese soldiers, including rape, torture, and extrajudicial executions. These abuses, coupled with Burmese government economic mismanagement which has further entrenched already pervasive poverty in rural Burma, have spawned a humanitarian catastrophe, forcing hundreds of thousands of ethnic Shan villagers to flee their homes for Thailand. In Thailand, they are denied refugee status and its legal protections, living at constant risk for arrest and deportation. Classified as "economic migrants," many are forced to work in exploitative conditions, including in the Thai sex industry, and Shan migrants often lack access to basic health services in Thailand. Available health data on Shan migrants in Thailand already indicates that this population bears a disproportionately high burden of infectious diseases, particularly HIV, tuberculosis, lymphatic filariasis, and some vaccine-preventable illnesses, undermining progress made by Thailand's public health system in controlling such entities. The ongoing failure to address the root political causes of migration and poor health in eastern Burma, coupled with the many barriers to accessing health programs in Thailand by undocumented migrants, particularly the Shan, virtually guarantees Thailand's inability to sustainably control many infectious disease entities, especially along her borders with Burma. http://www.conflictandhealth.com/content/2/1/4 Voravit Suwanvanichkij Conflict and Health 2008, 2:4 Number of accesses: 140 2008-03-14 doi:10.1186/1752-1505-2-4 Conflict and Health 1752-1505 2 4 2008-03-14 Background: The fields of expertise of natural disasters and complex emergencies (CEs) are quite distinct, with different tools for mitigation and response as well as different types of competent organizations and qualified professionals who respond. However, natural disasters and CEs can occur concurrently in the same geographic location, and epidemics can occur during or following either event. The occurrence and overlap of these three types of events have not been well studied. Methods: All natural disasters, CEs and epidemics occurring within the past decade (1995–2004) that met the inclusion criteria were included. The largest 30 events in each category were based on the total number of deaths recorded. The main databases used were the Emergency Events Database for natural disasters, the Uppsala Conflict Database Program for CEs and the World Health Organization outbreaks archive for epidemics.AnalysisDuring the past decade, 63% of the largest CEs had ≥1 epidemic compared with 23% of the largest natural disasters. Twenty-seven percent of the largest natural disasters occurred in areas with ≥1 ongoing CE while 87% of the largest CEs had ≥1 natural disaster. Conclusion: Epidemics commonly occur during CEs. The data presented in this article do not support the often-repeated assertion that epidemics, especially large-scale epidemics, commonly occur following large-scale natural disasters. This observation has important policy and programmatic implications when preparing and responding to epidemics. There is an important and previously unrecognized overlap between natural disasters and CEs. Training and tools are needed to help bridge the gap between the different type of organizations and professionals who respond to natural disasters and CEs to ensure an integrated and coordinated response. http://www.conflictandhealth.com/content/1/1/2 Paul B Spiegel, Phuoc Le, Mija-Tesse Ververs and Peter Salama Conflict and Health 2007, 1:2 Number of accesses: 119 2007-03-01 doi:10.1186/1752-1505-1-2 Conflict and Health 1752-1505 1 2 2007-03-01 Background: Conflict in Chechnya has resulted in over a decade of violence, human rights abuses, criminality and poverty, and a steady flow of displaced seeking refuge throughout the region. At the beginning of 2004 MSF undertook quantitative surveys among the displaced populations in Chechnya and neighbouring Ingushetia. Methods: Surveys were carried out in Ingushetia (January 2004) and Chechnya (February 2004) through systematic sampling. Various conflict-related factors contributing to ill health were researched to obtain information on displacement history, living conditions, and psychosocial and general health status. Results: The average length of displacement was five years. Conditions in both locations were poor, and people in both locations indicated food shortages (Chechnya (C): 13.3%, Ingushetia (I): 11.3%), and there was a high degree of dependency on outside help (C: 95.4%, I: 94.3%). Most people (C: 94%, I: 98%) were confronted with violence in the past. Many respondents had witnessed the killing of people (C: 22.7%, I: 24.1%) and nearly half of people interviewed witnessed arrests (C: 53.1%, I: 48.4%) and maltreatment (C: 56.2%, I: 44.5%). Approximately one third of those interviewed had directly experienced war-related violence. A substantial number of people interviewed – one third in Ingushetia (37.5%) and two-thirds in Chechnya (66.8%) – rarely felt safe. The violence was ongoing, with respondents reporting violence in the month before the survey (C: 12.5%, I: 4.6%). Results of the general health questionnaire (GHQ 28) showed that nearly all internally displaced persons interviewed were suffering from health complaints such as somatic complaints, anxiety/insomnia, depressive feelings or social dysfunction (C: 201, 78.5%, CI: 73.0% – 83.4%; I: 230, 81.3%, CI: 76.2% – 85.6%). Poor health status was reflected in other survey questions, but health services were difficult to access for around half the population (C: 54.3%, I: 46.6%).DiscussionThe study demonstrates that the health needs of internally displaced in both locations are similarly high and equally unaddressed. The high levels of past confrontation with violence and ongoing exposure in both locations is likely to contribute to a further deterioration of the health status of internally displaced. As of March 2007, concerns remain about how the return process is being managed by the authorities. http://www.conflictandhealth.com/content/1/1/4 Kaz de Jong, Saskia van der Kam, Nathan Ford, Sally Hargreaves, Richard van Oosten, Debbie Cunningham, Gerry Boots, Elodie Andrault and Rolf Kleber Conflict and Health 2007, 1:4 Number of accesses: 112 2007-03-13 doi:10.1186/1752-1505-1-4 Conflict and Health 1752-1505 1 4 2007-03-13 Although epidemiology is increasingly contributing to policy debates on issues of conflict and human rights, its potential is still underutilized. As a result, this article calls for greater collaboration between public health researchers, conflict analysts and human rights monitors, with special emphasis on retrospective, population-based surveys. The article surveys relevant recent public health research, explains why collaboration is useful, and outlines possible future research scenarios, including those pertaining to the indirect and long-term consequences of conflict; human rights and security in conflict prone areas; and the link between human rights, conflict, and International Humanitarian Law. http://www.conflictandhealth.com/content/1/1/11 Oskar NT Thoms and James Ron Conflict and Health 2007, 1:11 Number of accesses: 111 2007-11-15 doi:10.1186/1752-1505-1-11 Conflict and Health 1752-1505 1 11 2007-11-15