Estimating landmine casualty rates in eastern Burma: Enhancing the validity of case-report data with cluster-sample surveys

Despite calls to improve the accuracy and precision of landmine casualty rate estimates, most reports rely on case counts to quantify the burden of landmine-related injury. Accurate assessment of landmine risk is particularly urgent in active conflict areas in eastern Burma in order to improve services and to plan for post-conflict integration of displaced populations. Through a case study among 230,000 displaced persons in Karen State from 2003 to 2007 in eastern Burma, the audience will learn how cluster sample surveys can enhance the validity of case-report data to describe the epidemiology of human rights violations (HRVs) in conflict settings.

The Backpack Health Worker Team (BPHWT) and Karen Department of Health and Welfare (KDHW) deliver health services to contiguous populations in active conflict areas of Karen State. BPHWT and KDHW calculated landmine casualty rates by dividing the annual number of acute landmine injuries from clinical record forms by the respective mid-year target populations of the BPHWT (140,000) and KDHW (89,000). A series of five cluster sample mortality surveys provided an independent estimation of landmine casualties and their association with HRVs.

Over five years, BPHWT and KDHW recorded 469 landmine injuries, corresponding to annualized rates of 2.3 (95% CI 1.9 – 2.6) and 8.0 (95% CI 7.1 – 8.9) landmine casualties per 10,000 per year, respectively. In addition, landmine casualties reported by respondents in the 12 months preceding each of five cluster sample surveys conducted over the same period produced annual casualty rate estimates ranging from 3.2 (95% CI 0.7 – 9.3) to 14.3 (95% CI 8.3 – 23.2) per 10,000 per year. Households reporting landmine injuries in the 2004 BPHWT survey were more likely to report forced displacement (OR 3.89, 95% CI 1.01 - 5.0); forced labor (OR 2.62; 0.71 - 9.61); and food destruction or theft (OR 1.82, 95% CI 1.16 - 2.89).

Landmine casualty rates in eastern Burma are comparable to rates reported from other heavily mined conflict areas, and are associated with exposure to human rights abuses. The incorporation of landmine-related questions into population-based mortality and/or nutrition surveys facilitates the validation of estimates from case-report data, and could enhance estimations of the burden of landmines in other humanitarian settings.