Deaths and injuries caused by landmines in Mozambique
Alberto Ascherio, Robin Biellik, Andy Epstein, Gail Snetro, Steve Gloyd, Barbara Ayotte, Paul R Epstein
Landmines in Mozambique are still causing death and injuries years after the initial dispute. Since 1980, 3400 people have had an amputation because of landmine injuries. However, there are no direct estimates of the number of deaths or casualties which are not treated in hospitals,
In March, 1994, a medical team assembled by Physicians for Human Rights (PHR) conducted household surveys in the province of Manica and in the sub-district of Metuchira, province of Sofala. The object was to assess the frequency and severity of injuries and mortality caused by landmines in the civilian population. We found ratios of 8.1 and 16.7 casualties per 1000 living people in Manica and Metuchira, respectively. The prevalence of amputee’s was 3.2 per 1000 in Manica, and 2.3 in Metuchira. These figures are several folds higher than suggested by hospital data. The case fatality rate was 48%. Most of the victims were civilians (68%) and were injured by antipersonnel mines (81%). 16% of victims were women, and 7% were under 15 years of age.
Our results suggest that the impact of landmines is substantially higher than originally thought.
Published courtesy of: Lancet 1995; 346: 721-4.
Correspondence to: Dr Paul R Epstein, Physicians for Human Rights, 100 Boylston Street, Suite 702, Boston, MA 02116, USA
Social cost of landmines in four countries: Afghanistan, Bosnia, Cambodia and Mozambique
Neil Andersson, Cesar Palha da Sousa, Sergio Paredes
Objectives: To document the effects of landmines on the health and social conditions of communities in four affected countries.
Design: A cross design of cluster survey and rapid appraisal methods including a household questionnaire and qualitative data from key informants, institutional reviews, and focus groups of survivors of landmines from the same communities.
Setting: 206 communities, 37 in Afghanistan, 66 in Bosnia, 38 in Cambodia and 65 in Mozambique.
Subjects: 174,489 people living in 32,904 households in the selected communities.
Main outcome measures: Effects of landmines on food security, residence, livestock, and mine injuries; physical, psychological, social and economic costs of injuries during medical care and rehabilitation.
Results: Between 25% and 87% of households had daily activities affected by landmines. Based on expected production without the mines, agricultural production could increase by 88-200% in different regions of Afghanistan, 11% in Bosnia, 135% in Cambodia and 3.6% in Mozambique. A total of 54,554 animals was lost because of landmines, with a minimum cash value of $6.5m, or nearly $200 per household. Overall, 6% of households (1964) reported a landmine victim; a third of victims died in the blast. One in 10 of the victims was a child. The most frequent activities associated with landmine incidents were agricultural or pastoral, except in Bosnia where more than half resulted from military activities, usually during patrols. Incidences have more than doubled between 1980-3 and 1990-3 excluding the incidents in Bosnia. Some 22% of victims (455/2100) were from households reporting attempts to remove landmines; in these households there was a greatly increased risk of injury (odds ratio 4.2 and risk difference 19% across the four countries). Lethality of the mines varied; in Bosnia each blast killed an average of 0.54 people and injured 1.4, whereas in Mozambique each blast killed 1.45 people and wounded 1.27. Households with a landmine victim were 40% more likely to experience difficulty in providing food for the family. Family relationships were affected for around one in every four victims and relationships with colleagues in 40%.
Conclusions: Landmines seriously undermine the economy and food security in affected countries; they kill and maim civilians at an increasing rate. The expense of medical care and rehabilitation add economic disability to the physical burden. Awareness of land mines can be targeted at high risk attitudes, such as those associated with tampering with mines.
Published courtesy of: BMJ 1995; 311: 718-21
Correspondence to: Professor Neil Andersson, CIET international, 847a Second Avenue, Suite 387, New York, NY 10017, USA
Screening for glaucoma why is the disease underdetected?
Maurice W Tuck, Ronald P Crick
A review of 15 population-based glaucoma prevalence surveys in Western Europe, the US, the West Indies and Japan shows that the proportion of patients with the condition who had previously gone undetected was generally at least 50%.
Possible reasons for underdetection of glaucoma have been considered in relation to England and Wales, where most patients with glaucoma are initially detected during the course of sight tests in connection with providing spectacle lenses. It was found that: (i) a high proportion of the population over 40 > ears of age attends fairly regularly for a sight lest; (ii) the standard of primary testing for glaucoma is very uneven – those examiners who test comprehensively detect about 50% more cases than average; and (iii) referral criteria, which reflect the need not to overload hospital eye clinics, inevitably exclude many patients who are in apparently low risk categories.
Both the population survey data and the subsequent analysis suggest that underdetection is most pronounced in patients with glaucoma of the normal pressure type.
Published courtesy of: Drugs & Aging 1997; 10: 1-9
Correspondence to: Mr Ronald P Crick, Consultant Ophthalmologist, International Glaucoma Association, King’s College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
Causes of blindness in northwest Cambodia
Heather Jackson FRCOphth, Allen Foster FRCS FRCOphth
A hospital-based study in the northwest of Cambodia identified 453 blind adults and 30 blind children seen consecutively at the provincial ophthalmic department between January and September 1994. Blindness was defined as a visual acuity of less than 3/60 in the better eye. Cataract was the cause of blindness in 266 (59%) adults, of which 15 cases (3.3%) were surgical complications. Sixty-three cases (14%) were due to glaucoma and 53 (11.5%) patients had corneal scars, of which 12 (2.5%) were due to trachoma. Bilateral trauma, usually due to landmine injuries, accounted for 17 patients (4%). Of the 30 blind children, corneal scarring accounted for 12 cases (40%), congenital causes in 14 (47%) and optic atrophy secondary to meningitis for 4 (13%). There is at present an inadequate ophthalmological service for the vast majority of people living outside the capital Phnom Penh. These hospital-based data suggest that there is a need to train general doctors to surgically manage patients with visual loss from cataract and glaucoma, which together account for 70% of all cases of blindness, and highlight the need for a large population-based survey.
Published courtesy of: Ophthalmic Epidemiology 1997; 4: 27-32
Correspondence to: Miss H Jackson FRCOphth, Dept of Ophthalmology, King’s College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom