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Can J Surg. 2006 Feb;49(1):51-7.

Burden of injury during the complex political emergency in northern Uganda.

Author information

  • 1Canadian Network for International Surgery, Vancouver, BC. lett@cnis.ca

Abstract

BACKGROUND:

War injury is a public health problem that warrants global attention. This study aims to determine the burden of injury during a complex emergency in sub-Saharan Africa.

METHODS:

To determine the magnitude, causes, distribution, risk factors and cumulative burden of injury in a population experiencing armed conflict in northern Uganda since 1986 and to evaluate the living conditions and access to care for injury victims, we took a multistage, stratified, random sampling from the Gulu district to determine the rates of injury from 1994 to 1999. The Gulu district is endemic for malaria, tuberculosis, HIV and malnutrition and has a high maternal death rate. It is 1 of 3 districts in northern Uganda affected by war since 1986. The study participants included 8595 people from 1475 households. Of these, 73.0% lived in temporary housing, 46.0% were internally displaced and 81.0% were under 35 years of age. Trained interviewers administered a 3-part household survey in the local language. Quantitative data on injury, household environment, health care and demography were analyzed. Qualitative data from part 3 of the survey will be reported elsewhere. A similar rural district (Mukono) not affected by war was used for comparison. We studied injury risk factors, mortality and disability rates, accumulated deaths, access to care and living conditions.

RESULTS:

Of the study population, 14% were injured annually: gunshot injuries were the leading cause of death. The annual death rate from war injury was 7.8/1000 (95% confidence interval [CI] 7.0-8.5) and the disability rate was 11.3/1000 (95% CI 10.4-12.2). The annual excess injury mortality was 6.85/1000. Only 4.5% of the injured were combatants. Fifty percent of the injured received first aid, but only 13.0% of those who died reached hospital. The injury mortality in Gulu was 8.35-fold greater than that for Mukono.

CONCLUSIONS:

The crisis in Gulu can be considered a complex political emergency. Protracted conflicts should not be ignored because of a low rate of injury death since the cumulative total is high. Political emergencies should be monitored, and when the mortality exceeds 3.5%, international intervention is indicated. The international and national failings of this protracted conflict should be critically analyzed so that such political emergencies can be prevented or terminated.

PMID:
16524144
[PubMed - indexed for MEDLINE]
PMCID:
PMC3207517
Free PMC Article
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