Mortality in Iraq

Abstract

Crucial weaknesses exist in Gilbert Burnham and colleagues' study of Iraq's war-related mortality.1Burnham G Lafta R Doocy S Roberts L Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey.Lancet. 2006; 368: 1421-1428Summary Full Text Full Text PDF PubMed Scopus (407) Google ScholarFirst, 47 clusters seem to be too few for a large population experiencing highly localised violent events.Second, household sampling within clusters was not random: only households located on or near residential streets crossing a main street had a chance of inclusion,2Johnson NF Spagat M Gowley S Onnela J Reinert G Bias in epidemiological studies of conflict mortality.http://www.rhul.ac.uk/economics/Research/conflict-analysis/iraq-mortality/BiasPaper.htmlGoogle Scholar and only if located near the “start household” for that cluster.Third, it is infeasible that “One team could typically complete a cluster of 40 households in 1 day”. Assuming continuous interviewing for 10 h despite 55°C heat,3Burnham G Doocy S Dzeng E Lafta R Roberts L The human cost of the war in Iraq: a mortality study, 2002-2006. John Hopkins Bloomberg School of Public Health and Al Mustansiriya University School of Medicine.http://web.mit.edu/CIS/pdf/Human_Cost_of_War.pdfGoogle Scholar this allows 15 min per interview including walking between households and obtaining informed consent and death certificates. The improbability of so many interviews being done so quickly and reliance on “word of mouth among households” during selection and recruitment suggest potential sources of bias, ethical compromise, and risk to interviewees during interview-gathering.4Hicks MH Mortality after the 2003 invasion of Iraq: were valid and ethical field methods used in this survey?.http://www.hicn.org/research_design/rdn3.pdfGoogle ScholarIraq's suffering from war is properly reflected not by producing high-mortality findings, but by producing accurate mortality findings. The Iraq Living Conditions Survey5UN Development ProgrammeIraq living conditions survey 2004.http://www.iq.undp.org/ILCS/overview.htmGoogle Scholar provided such an example. In this study, ten randomly sampled households were interviewed per cluster in 2200 clusters across all governorates of Iraq to provide an estimate of conflict-related deaths within the same difficult field conditions.I declare that I have no conflict of interest. Crucial weaknesses exist in Gilbert Burnham and colleagues' study of Iraq's war-related mortality.1Burnham G Lafta R Doocy S Roberts L Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey.Lancet. 2006; 368: 1421-1428Summary Full Text Full Text PDF PubMed Scopus (407) Google Scholar First, 47 clusters seem to be too few for a large population experiencing highly localised violent events. Second, household sampling within clusters was not random: only households located on or near residential streets crossing a main street had a chance of inclusion,2Johnson NF Spagat M Gowley S Onnela J Reinert G Bias in epidemiological studies of conflict mortality.http://www.rhul.ac.uk/economics/Research/conflict-analysis/iraq-mortality/BiasPaper.htmlGoogle Scholar and only if located near the “start household” for that cluster. Third, it is infeasible that “One team could typically complete a cluster of 40 households in 1 day”. Assuming continuous interviewing for 10 h despite 55°C heat,3Burnham G Doocy S Dzeng E Lafta R Roberts L The human cost of the war in Iraq: a mortality study, 2002-2006. John Hopkins Bloomberg School of Public Health and Al Mustansiriya University School of Medicine.http://web.mit.edu/CIS/pdf/Human_Cost_of_War.pdfGoogle Scholar this allows 15 min per interview including walking between households and obtaining informed consent and death certificates. The improbability of so many interviews being done so quickly and reliance on “word of mouth among households” during selection and recruitment suggest potential sources of bias, ethical compromise, and risk to interviewees during interview-gathering.4Hicks MH Mortality after the 2003 invasion of Iraq: were valid and ethical field methods used in this survey?.http://www.hicn.org/research_design/rdn3.pdfGoogle Scholar Iraq's suffering from war is properly reflected not by producing high-mortality findings, but by producing accurate mortality findings. The Iraq Living Conditions Survey5UN Development ProgrammeIraq living conditions survey 2004.http://www.iq.undp.org/ILCS/overview.htmGoogle Scholar provided such an example. In this study, ten randomly sampled households were interviewed per cluster in 2200 clusters across all governorates of Iraq to provide an estimate of conflict-related deaths within the same difficult field conditions. I declare that I have no conflict of interest. Mortality in Iraq – Authors' replyJohan von Schreeb and colleagues point out that our interviewed households were only visited once. This is true, but past efforts at repeat interviewing in Iraq, Liberia, and Zaire have yielded more deaths on a second interview.1–3 Full-Text PDF