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Update on Mortality in the Democratic Republic of Congo: Results From a Third Nationwide Survey

  • Benjamin Coghlan, Pascal Ngoy, Flavien Mulumba, Colleen Hardy, Valerie Nkamgang Bemo, Tony Stewart, Jennifer Lewis and Richard J. Brennan...


Background: The humanitarian crisis in the Democratic Republic of Congo (DRC) has been among the world’s deadliest in recent decades. We conducted our third nationwide survey to examine trends in mortality rates during a period of changing political, security, and humanitarian conditions.

Methods: We used a 3-stage, household-based cluster sampling technique to compare east and west DRC. Sixteen east health zones and 15 west zones were selected with a probability proportional to population size. Four east zones were purposely selected to allow historical comparisons. The 20 smallest population units were sampled in each zone, 20 households in each unit. The number and distribution of households determined whether they were selected using systematic random or random walk sampling. Respondents were asked about deaths of household members during the recall period: January 2006–April 2007.

Findings: In all, 14,000 households were visited. The national crude mortality rate of 2.2 deaths per 1000 population per month (95% confidence interval [CI] 2.1–2.3) is almost 70% higher than that documented for DRC in the 1984 census (1.3) and is unchanged since 2004. A small but significant decrease in mortality since 2004 in the insecure east (rate ratio: 0.96, P = .026) was offset by increases in the western provinces and a transition area in the center of the country. Nonetheless, the crude mortality rate in the insecure east (2.6) remains significantly higher than in the other regions (2.0 and 2.1, respectively). Deaths from violence have declined since 2004 (rate ratio 0.7, P = .02).

Conclusions: More than 4 years after the official end of war, the crude mortality rate remains elevated across DRC. Slight but significant improvements in mortality in the insecure east coincided temporally with recent progress on security, humanitarian, and political fronts. (Disaster Med Public Health Preparedness. 2009;3:88–96)


Corresponding author

Address correspondence and reprint requests to Dr Benjamin Coghlan, Medical Epidemiologist, Centre for International Health, Burnet Institute, 85 Commercial Rd, Melbourne 3004, Australia(e-mail:


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1.Roberts, L.Mortality in Eastern DRC: Results From 5 Mortality Surveys. New York: International Rescue Committee; 2000.
2.Roberts, L, Belyadoumi, F, Cobey, L, et alMortality in the Eastern Democratic Republic of Congo: Results From 11 Mortality Surveys. New York: International Rescue Committee; 2001.
3.Roberts, L, Ngoy, P, Mone, C, et alMortality in the Democratic Republic of Congo: Results From a Nationwide Survey. New York: International Rescue Committee; 2002.
4.Roberts, L, Zantop, M.Elevated mortality associated with armed conflict—Democratic Republic of Congo, 2002. MMWR Morb Mort Wkly Report. 2003;52:469471.
5.Coghlan, B, Brennan, RJ, Ngoy, P, et alMortality in the Democratic Republic of Congo: a nationwide survey. Lancet. 2006;367:4451.
6. Departement du Plan. Direction des Etudes Macroeconomiques. Population and development in the Republic of Zaire: policies and programs. Accessed July 2, 2008.
7.Democratic Republic of Congo: Humanitarian Action Plan. New York: United Nations Office for the Coordination of Humanitarian Affairs; 2007.
8. State of the World’s Children Report 2007.New York: UNICEF; 2006.
9. Ministry of Health, Democratic Republic of Congo. Direction d’Etude et de Planification. Accessed April 2007.
10. World Health Organization, Expanded Programme on Immunization.Geneva: WHO; 1991.
11.Checchi, F, Roberts, L.Interpreting and Using Mortality Data in Humanitarian Emergencies: A Primer for Non-epidemiologists. Humanitarian Practice Network—Network Paper No. 52. London: Overseas Development Institute; 2005.
12. Minimum standards in health services. In: The Sphere Project: Humanitarian Charter and Minimum Standards in Disaster Response. Oxford, UK: Oxfam Publishing; 2004.
13. International Crisis Group. Katanga: The Congo’s Forgotten Crisis. Africa Report No. 103. Brussels. January 9, 2006. Accesssed October 25, 2007.
14.United Nations High Commissioner for Refugees. Handbook for Emergencies. 2nd ed. Geneva: UNHCR; 2000.
15. International Crisis Group. Congo: Consolidating the Peace. Africa report No. 128; 2007.
16. Tschoegl E, Degomme O, Guha-Sapir D. The Democratic Republic of Congo: a brief analysis of anthropometric surveys from 2000–2006. Centre for Epidemiology of Disasters Web site. Accessed January 8, 2007.
17. Medecins Sans Frontieres. Access to healthcare in post-war Sierra Leone. Summary of a 2005 survey in 4 districts: Kambia, Tonkolili, Bombali, Bo. MSF-Holland and MSF-Belgium. January 2006. Accessed October 2, 2007.
18. Sapir DG, Gomez VT. Angola: The human impact of war. A data review of field surveys in Angola between 1999 and 2005. Centre for Epidemiology of Disasters Web site. Accessed April 14, 2009.
19. Centre for the Research on the Epidemiology of Disasters. Complex Emergency Database (CE-DAT). Accessed October 25, 2007.
20.Ghobarah, HA, Russett Huth, P.The post-war public health effects of civil conflict. Soc Sci Med. 2004;59:869884.
21.World Health Organization. World Health Statistics 2008. Geneva: WHO; 2008.
22. Brennan R, Husarska A. Inside Congo, an unspeakable toll. Washington Post. July 16, 2006:B3.
23. Prendergast J, Thomas-Jensen C. Averting the nightmare scenario in eastern Congo. Enough Strategy Paper No. 7. September 2007. Accessed April 14, 2009.
24.Rose, AMC, Grais, RF, Coulombier, D, et alA comparison of cluster and systematic sampling methods for measuring crude mortality. Bull WHO. 2006;84:290296.
25.Working Group for Mortality Estimation in Emergencies. Wanted: studies on mortality estimation methods for humanitarian emergencies, suggestions for future research. Emerg Themes Epidemiol. 2007;4:9.
26.Spiegel, PB, Salama, P.War and mortality in Kosovo, 1998–99: an epidemiological testimony. Lancet. 2000;355:22042209.
27.Depoortere, E, Checchi, F, Broillet, F, et alViolence and mortality in West Darfur, Sudan (2003–04): epidemiological evidence from 4 surveys. Lancet. 2004;364:13151320.
28.Grais, RF, Rose, AMC, Guthmann, JP.Don’t spin the pen: 2 alternative methods for second-stage sampling in urban cluster surveys. Emerg Themes Epidemiol. 2007;4:8.



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