Biomedical subjects
Debarati Guha-Sapir
Publications and source records attributed to Debarati Guha-Sapir.
Aid after disasters: evidence for psychosocial services needs strengthening.
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Dengue fever: new paradigms for a changing epidemiology.
Dengue is the most important arthropod-borne viral disease of public health significance. Compared with nine reporting countries in the 1950s, today the geographic distribution includes more than 100 countries worldwide. Many of these had not reported dengue for 20 or more years and several have no known history of the disease. The World Health Organization estimates that more than 2.5 billion people are at risk of dengue infection. First recognised in the 1950s, it has become a leading cause of child mortality in several Asian and South American countries.This paper reviews the changing epidemiology of the disease, focusing on host and societal factors and drawing on national and regional journals as well as international publications. It does not include vaccine and vector issues. We have selected areas where the literature raises challenges to prevailing views and those that are key for improved service delivery in poor countries.Shifts in modal age, rural spread, and social and biological determinants of race- and sex-related susceptibility have major implications for health services. Behavioural risk factors, individual determinants of outcome and leading indicators of severe illness are poorly understood, compromising effectiveness of control programmes. Early detection and case management practices were noted as a critical factor for survival. Inadequacy of sound statistical methods compromised conclusions on case fatality or disease-specific mortality rates, especially since the data were often based on hospitalised patients who actively sought care in tertiary centres.Well-targeted operational research, such as population-based epidemiological studies with clear operational objectives, is urgently needed to make progress in control and prevention.
Civil conflicts in four african countries: a five-year review of trends in nutrition and mortality.
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Conflict-related mortality: an analysis of 37 datasets.
Mortality rates are among the main indicators of the human impact of armed conflict and many surveys have assessed this impact both for targeting and evaluating humanitarian aid programmes. Almost no epidemiological analysis such as calculating relative risk was performed nor were reference values clearly described. Here the aim is to review published mortality rates for a better understanding of age-specific mortality in armed conflict. Published mortality rates from conflict situations were collected and pre-conflict reference rates composed. We calculated the relative risk of dying in conflict compared to pre-conflict for children under 5 and people older than five years old. Although limited by reporting inadequacies, the results confirm the high vulnerability of children < 5 but identify a higher relative risk of dying among the > or = 5 year olds. Although not entirely new, this observation is not fully understood. Further systematic epidemiological research is needed to estimate and understand the impact of armed conflict on mortality.
The importance of conflict-related mortality in civilian populations.
Civil conflict affects the health of individuals in many countries, and draws a substantial amount of international humanitarian aid. The most widely used indicator of the effect of conflict is the rate of civilian death during conflict. We aimed to assess mortality estimates from conflicts in Sudan, Somalia, the Democratic Republic of Congo, and Afghanistan by calculating the relative risk of death during and after conflict compared with that in preconflict peacetime. Katale, in the Democratic Republic of Congo, had the highest relative risk of death during conflict (11.2 [9.1-13.8] and 103.3 [94.7-112.6], for children younger than 5 years and the whole population, respectively). Our results suggest that high rates of civilian mortality are determined more by the pre-existing fragility of the affected population than the intensity of the conflict. In many instances, a high rate of civilian deaths during conflict shows that international development aid before the conflict was grossly inadequate.
International humanitarian aid: paradigm lost.
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What have we learned? Capacity building for health responses in disasters.
This is a synthesis of the presentations and discussions pertaining to Capacity Building for Health Responses in Disasters of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO), in Phuket, Thailand, 04-06 May 2005. The topics discussed included: (1) Specific goals; (2) Main focal areas, including available training programs, country-specific training programs, targeted technical assistance for training programs, certified training programs, and ensuring that funding is available for training; (3) What has been achieved in building capacity; (4) Challenges; (5) Where capacity building is needed; and (6) Conclusions and recommendations.