Health and human rights in eastern Myanmar after the political transition: a population-based assessment using multistaged household cluster sampling.

Parveen Kaur Parmar,Sharon Low,Nai Chay Mon,Conrad Otterness,Ravi Goyal,Daniel Reh,Pue P Mhote,Charlene C Barina,Nai Aye Lwin,Nakul Singh,Eh Kalu Shwe Oo,Cynthia Maung,Adam K Richards,Saw Win Kyaw,Saw Nay Htoo,Kyaw Thura Tun,Naw Merry Moo,Jerome A Singh

doi:10.1371/journal.pone.0121212

Abstract

BackgroundMyanmar transitioned to a nominally civilian parliamentary government in March 2011. Qualitative reports suggest that exposure to violence and displacement has declined while international assistance for health services has increased. An assessment of the impact of these changes on the health and human rights situation has not been published.Methods and FindingsFive community-based organizations conducted household surveys using two-stage cluster sampling in five states in eastern Myanmar from July 2013-September 2013. Data was collected from 6, 178 households on demographics, mortality, health outcomes, water and sanitation, food security and nutrition, malaria, and human rights violations (HRV). Among children aged 6-59 months screened, the prevalence of global acute malnutrition (representing moderate or severe malnutrition) was 11.3% (8.0 – 14.7). A total of 250 deaths occurred during the year prior to the survey. Infant deaths accounted for 64 of these (IMR 94.2; 95% CI 66.5-133.5) and there were 94 child deaths (U5MR 141.9; 95% CI 94.8-189.0). 10.7% of households (95% CI 7.0-14.5) experienced at least one HRV in the past year, while four percent reported 2 or more HRVs. Household exposure to one or more HRVs was associated with moderate-severe malnutrition among children (14.9 vs. 6.8%; prevalence ratio 2.2, 95% CI 1.2-4.2). Household exposure to HRVs was associated with self-reported fair or poor health status among respondents (PR 1.3; 95% CI 1.1 – 1.5).ConclusionThis large survey of health and human rights demonstrates that two years after political transition, vulnerable populations of eastern Myanmar are less likely to experience human rights violations compared to previous surveys. However, access to health services remains constrained, and risk of disease and death remains higher than the country as a whole. Efforts to address these poor health indicators should prioritize support for populations that remain outside the scope of most formal government and donor programs.

Highlights

After holding elections in 2010, Burma/Myanmar transitioned to a nominally civilian parliamentary government in March 2011
This large survey of health and human rights demonstrates that two years after political transition, vulnerable populations of eastern Myanmar are less likely to experience human rights violations compared to previous surveys
The male to female ratio was lower among ages 15–25 (0.93), consistent with previous surveys in eastern Myanmar and other conflict-affected regions where young men are lost to war or migration [4]

Summary

Introduction

After holding elections in 2010, Burma/Myanmar (hereafter Myanmar) transitioned to a nominally civilian parliamentary government in March 2011. Accurate information evaluating the impact of national efforts to improve health and human rights after the recent political transition is needed. The neonatal mortality rate in Myanmar was 26, as opposed to 8 in Thailand [3]. Official national statistics fail to capture important variation in health status across geographic regions and subpopulations. As a result, these statistics likely underestimate health risks in conflict-affected border regions where state-sponsored data collection and health system responses have been constrained for decades [4]. Myanmar transitioned to a nominally civilian parliamentary government in March 2011. An assessment of the impact of these changes on the health and human rights situation has not been published

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