Conflict-related excess mortality and disability in Northwest Syria

Alhiraki, Omar Alrashid; Fahham, Ola; Dubies, Hussam Alden; Hatab, Jawad Abou; Ba’Ath, Muhammad Eyad

doi:10.1136/bmjgh-2022-008624

Cited by 10 publications

(6 citation statements)

References 24 publications

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“…However, an acknowledged limitation of this work was underrepresentation from insecure, hard-toaccess areas, namely the main constraint we sought to address using remote data collection methods. By comparison, a 2020 cluster sample survey in Northwest Syria estimated that the CMR increased 3.55 times (from 16.07 [95%CI 9.91-22.23] to 57.12 [95%CI 48.95-65.30] per 10, 000, p < 0.001) during the 2011-2020 con ict period when compared to the pre-con ict period (11). These ndings suggest excess deaths of 874, 000 over the 10-year con ict period.…”

Section: Discussionmentioning

confidence: 98%

Adult mortality patterns in Yemen before and during armed conflict and the COVID-19 pandemic: Evidence from a web survey of the global diaspora

McGowan

Alhaffar

Ekoriko

et al. 2023

Preprint

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Background The ongoing war in Yemen has created a severe and protracted crisis that has left nearly three-quarters of the population in need of urgent humanitarian assistance. Despite eight years of conflict there exist few robust estimates of how the crisis and COVID-19 pandemic have affected mortality in Yemen. The security situation has limited access to affected populations and thus required novel alternatives to local mortality surveys. Methods We used a web-based, respondent-driven sampling method to disseminate a mortality survey amongst the global Yemeni diaspora. We used mortality estimation methods and survival analysis to calculate mortality and/or survivorship amongst respondents’ close family members in Yemen including adults aged 50+, siblings, and children under five years. Results Eighty-nine eligible respondents completed the survey. Respondents provided data on the status of 1704 individuals of whom 85 (5%) had died; of these 65 (3.8%) were reported to have died in Yemen. An analysis of survivorship of respondents’ parents after their 50th birthday (adjusted for birth cohort and gender) provided weak evidence that the war and pandemic periods were associated with higher mortality when compared to the pre-war period. Analysis of the subset of individuals who died in Yemen also suggested an increased hazard of dying during the war/pandemic period; however, these results were non-significant. Sibling mortality amongst those aged 15–49 was 0.7 per 1000 person-years during the pre-war period compared to 1.1 during the war/pandemic period amongst males, and 0.8 versus 0.0 amongst females; however, these estimates reflected small numbers of deaths. The number of deaths amongst children under five in Yemen was too low to allow meaningful analysis; only three of the seven deaths in this group occurred during the analysis period. Conclusions Our data suggest increased mortality during the war/pandemic period, compared to the pre-war period, among elderly Yemenis. Our findings require careful interpretation as our small and non-representative sample appeared skewed towards higher-income, urban communities. Surveys of diaspora populations offer a promising means of describing mortality patterns in crisis-affected populations; however, large numbers of respondents are likely required to achieve accurate mortality estimates and attempt adjustment for selection bias.

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Section: Discussionmentioning

confidence: 98%

Adult mortality patterns in Yemen before and during armed conflict and the COVID-19 pandemic: Evidence from a web survey of the global diaspora

McGowan

Alhaffar

Ekoriko

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…However, an acknowledged limitation of this work was underrepresentation from insecure, hard-to-access areas (the main constraint we sought to address using remote data collection methods). By comparison, a 2020 cluster sample survey in Northwest Syria estimated that the CMR increased 3.55 times (from 16.07 [95% CI 9.91–22.23] to 57.12 [95% CI 48.95–65.30] per 10, 000, p < 0.001) annually during the 2011–2020 conflict period, when compared to the pre-conflict period [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Adult mortality patterns in Yemen before and during armed conflict: evidence from a web survey of the global diaspora

McGowan,

Alhaffar,

Ekoriko

et al. 2023

Confl Health

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Background The ongoing war in Yemen has created a severe and protracted crisis that has left nearly three-quarters of the population in need of urgent humanitarian assistance. Despite eight years of conflict there exist few robust estimates of how the conflict (and the conflict combined with the COVID-19 pandemic) have affected mortality in Yemen. As the security situation has limited access to affected populations we have designed a novel alternative to local mortality surveys. Methods We used a web-based, respondent-driven sampling method to disseminate a mortality survey amongst the global Yemeni diaspora. We used Cox proportional hazards survival models to estimate the association between the exposure (i.e. between the pre-conflict, conflict, and conflict/pandemic periods) and mortality risk, adjusted for gender and birth cohort. Results Eighty-nine eligible respondents completed the survey. Respondents provided data on the status of 1704 individuals of whom 85 (5%) had died; of these 65 (3.8%) were reported to have died in Yemen. An analysis of survivorship of respondents’ parents after their 50th birthday (adjusted for gender and birth cohort) provided weak evidence that the war and pandemic periods were associated with higher mortality when compared to the pre-war period. Analysis of the subset of individuals who died in Yemen also suggested an increased, but non-significant hazard of dying during the war/pandemic period: this association tended towards significance when allowing for varying degrees of out-migration from Yemen across the cohort. The number of deaths amongst respondents’ siblings and children under five in Yemen were too low to allow meaningful analysis. Conclusions Our data suggest increased mortality during the war/pandemic period, compared to the pre-war period, among older Yemeni adults. However, our findings require careful interpretation as our study design cannot establish causation, and as our small and non-representative sample appeared skewed towards higher-income, urban communities. Surveys of diaspora populations offer a promising means of describing mortality patterns in crisis-affected populations; though, large numbers of respondents are likely required to achieve accurate mortality estimates and to adjust for selection bias.

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“…During the conflict, information systems collapsed, resulting in limited reliable data and uncertainty regarding healthcare figures. 49 Therefore, convenience sampling was used to cover the most accessible diabetic clinics to create a representative sample rather than recruiting a community dwelling diabetes population. Due to security concerns, our sample was exclusively taken from Idlib province.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Level of and factors associated with foot self‐care among people with diabetes in Idlib Province of Northwest Syria: A cross‐sectional study

Al‐Ashkar,

Alhussein,

Eido

et al. 2024

Health Science Reports

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Background and aimsDiabetic foot and lower limb problems are among the most neglected complications during the Syrian armed conflict due to the absence of a functioning health infrastructure, including early detection and timely management of limb‐threatening wounds. This study aimed to determine self‐reported diabetes‐related foot disease (DRFD), adherence to recommended foot self‐care (FSC) practices, and associated factors among people with diabetes in war‐torn Northwest Syria (NWS).MethodsThis was a cross‐sectional study conducted at six primary care clinics in Idlib, NWS, between March 27 and April 17, 2022, utilizing the validated interviewer‐administered Diabetes Foot Disease and Foot Care Questionnaire. Data on demographic characteristics, DRFD, and FSC practices were collected. FSC score was determined by adding the points from all 12 FSC items, with a maximum score of 48, and were categorized into very poor (≤12), poor (13–24), moderate (25–36), and good (37–48). A convenience sample of 331 consecutive Syrians, aged ≥18 years, with diabetes, were invited. Multiple linear regression was used to identify variables associated with FSC practices.ResultsA total of 328 patients completed the questionnaire (response rate: 99.1%). The overall FSC score was average (mean total score 27.24, SD 7.03). Over one‐third (37.8%) had a very poor/poor score, 50.3% had an average score, and 11.9% had a good score. Household income/month of ≥51 USD (β = 2.6, 95% confidence interval [95% CI]:1.06–4.1, p = 0.001) and diabetes duration of ≥10 years (β = 1.8, 95% Cl: 0.2–3.4, p = 0.027) significantly predicted better FSC practice.ConclusionA significant proportion of participants had inadequate adoption FSC behaviors. Higher socioeconomic status was associated with better FSC practices. Future research should evaluate diabetic foot education and professional foot care in this population.

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Conflict-related excess mortality and disability in Northwest Syria

Cited by 10 publications

References 24 publications

Adult mortality patterns in Yemen before and during armed conflict and the COVID-19 pandemic: Evidence from a web survey of the global diaspora

Adult mortality patterns in Yemen before and during armed conflict and the COVID-19 pandemic: Evidence from a web survey of the global diaspora

Adult mortality patterns in Yemen before and during armed conflict: evidence from a web survey of the global diaspora

Level of and factors associated with foot self‐care among people with diabetes in Idlib Province of Northwest Syria: A cross‐sectional study

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