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

Conflict and Health

Research

Sawsan Al-Refai¹  Francesco Checchi²  Lucy Bell²  Catherine R. McGowan²  Promise Ekoriko³  Mervat Alhaffar⁴  Jamal Badr⁵ 

[1] City of Ottawa, K2J 2V4, Ottawa, Canada;Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK;Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK;Information Technology Services, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK;Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK;Syria Research Group, London School of Hygiene & Tropical Medicine and National University of Singapore School of Public Health, London, UK;Het Grote Midden Oosten Platform [The Greater Middle East Platform], The Hague, Netherlands;

关键词: Respondent-driven sampling;    Mortality estimation;    webRDS;    Sibling survival;    Child survival;    Conflict;    Yemen;    Diaspora;   

DOI  :  10.1186/s13031-023-00535-8

 received in 2023-02-20, accepted in 2023-07-31,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsWe 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.ResultsEighty-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.ConclusionsOur 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.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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