content.nejm.org/cgi/content/full/NEJMp0709003
During conflicts, an estimation^ of the death rate is further complicated by the difficulties^ involved in creating a valid sampling frame, the problem of^ reporting bias, and obstacles to accurate ascertainment of causes^ of death.
Information on all deaths within a household was^ sought, in an effort to estimate overall and cause-specific^ rates of death. The group obtained an estimate of 151,000 violent^ deaths, with a purported 95% confidence interval of 104,000^ to 223,000 -- a massive death toll -- since the 2003^ invasion.
Get Slide Numbers of Households Visited in Each Governorate of Iraq for the Iraq Family Health Survey. Map is from the Central Organization for Statistics and Information Technology of Iraq.
Get Slide The ranges in studies by the Iraq Family Health Survey and by Burnham et al. data from the Iraq Body Count represent absolute minimum and maximum counts. How is it that these numbers vary so widely, given that there^ can be only one true answer? The IFHS study group does not directly^ address this question, but it deserves speculation. The probable^ cause is that the techniques used to obtain the estimates differ^ radically from one another. The Iraq Body Count collects details^ from every available distinct report for all identified incidents^ in which civilians were killed. Deaths are included if they^ appear in a minimum of two independent data sources, and they^ are cross-checked with media reports and with the records of^ hospitals, morgues, and nongovernmental organizations, as well^ as with official figures, to produce a credible record of known^ deaths and incidents (though as of December 21, 2007, credible^ single-source reports will now be recorded).
The survey methods have been scrutinized,^ and observers have put forward convincing arguments both that^ it does and that it does not overestimate mortality. One of^ the issues under debate is whether the clusters that were surveyed^ were nonrandomly distributed owing to "main-street bias" (an^ oversampling of highly trafficked areas). Mortality^ estimates that are derived from surveying deaths of siblings^ were also calculated, but this method may also be subject to^ such underreporting. The circumstances^ that are required to produce high-quality public health statistics^ contrast starkly with those under which the IFHS study group^ worked. What we can discuss, however, are^ the implications of this work for mortality-estimation research^ in areas in which violent conflict persists. The goal should be to ensure^ that decisions regarding epidemiologic methods for estimating^ mortality in high-risk populations are based on the best possible^ evidence; References 1 Working Group for Mortality Estimation in Emergencies. Wanted: studies on mortality estimation methods for humanitarian emergencies, suggestions for future research.
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