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

Questions autour de la democratie sanitaire en Afrique

The 1990s witnessed great progress in increasing community participation in the management of health care services as an objective for reform of healthcare systems especially in urban areas benefiting from funding from the international community. Community participation has taken various forms from one country to another in terms of sources of healthcare training (public; private; or both); organization of management committees (inclusion or not of healthcare personnel); and scope of public service assigned to district health care units (preve n t ive and/or curative care; management of proceeds from provision of health care procedures and/or medication; etc.). These strategies have had variable results and; although some urban programs have been evaluated; no attempt has been made to use this experience as a basis for analyzing the political implications of issues involving citizenship and public health. This report presents some ideas on these issues from the point of view of both governments and citizens and restates the purpose of user participation in healthcare services in Africa. That intent involves the need not only to increase household contributions to the cost of healthcare especially within the uncertain economic environment of urban areas but also to improve access to as well as quality of healthcare services