Mortality and health among internally displaced persons in western Kenya following post-election Violence; 2008: novel use of demographic surveillance

Objective To evaluate mortality and morbidity among internally displaced persons (IDPs) who relocated in a demographic surveillance system (DSS) area in western Kenya following post-election violence. Methods In 2007; 204 000 individuals lived in the DSS area; where field workers visit households every 4 months to record migrations; births and deaths. We collected data on admissions among children 5 years of age in the district hospital and developed special questionnaires to record information on IDPs. Mortality; migration and hospitalization rates among IDPs and regular DSS residents were compared; and verbal autopsies were performed for deaths. Findings Between December 2007 and May 2008; 16 428 IDPs migrated into the DSS; and over half of them stayed 6 months or longer. In 2008; IDPs aged 15.49 years died at higher rates than regular residents of the DSS (relative risk; RR: 1.34; 95confidence interval; CI: 1.004.1.80). A greater percentage of deaths from human immunodeficiency virus (HIV) infection occurred among IDPs aged . 5 years (53) than among regular DSS residents (25.29) (P 0.001). Internally displaced children 5 years of age did not die at higher rates than resident children but were hospitalized at higher rates (RR: 2.95; 95CI: 2.44.3.58). Conclusion HIV-infected internally displaced adults in conflict-ridden parts of Africa are at increased risk of HIV-related death. Relief efforts should extend to IDPs who have relocated outside IDP camps; particularly if afflicted with HIV infection or other chronic conditions

Has the HIV Epidemic in Rural Mwanza; Tanzania Reached a Plateau?

Data from studies in Mwanza Region in Tanzania suggest stabilising HIV prevalence. The objective was to determine the factors that may have contributed to the relatively stable pattern of the HIV prevalence observed in the comparison communities of the Mwanza STD treatment trial in rural Mwanza Region; Tanzania between 1991 and 2001. Socio-demographic; sexual behaviour and HIV prevalence data in two surveys conducted 10 years apart in the same communities using similar sampling schemes were compared. The age standardised HIV prevalence was 3.8(95CI: 3.2-4.6) in 1991 and 4.3(95CI: 2.8-6.4) in 2001 for males (Z= - 0.56; P= 0.58); and 4.5(95CI: 3.8-5.3) in 1991 and 3.9(95CI: 2.6-5.6) in 2001 for females (Z= 0.64; P= 0.52). Participants in the 2001 survey reported significantly fewer lifetime and recent sexual partners (12 months); Sexually Transmitted disease syndromes (12 months) and significantly more condom use at last sex with casual partners than those in the 1991 behaviour survey. We conclude that STD/ HIV infection prevention activities in rural Mwanza may be responsible for changes in risky sexual behaviour and have successfully impeded the spread of HIV infection. These activities should therefore be enhanced to reduce HIV incidence even further. In addition; modelling studies are needed to assess whether mobility of HIV infected people out of rural communities may stabilise the prevalence of the HIV infection in the general populations