Cross-sectional survey in Central African Republic finds mortality 4-times higher than official UN statistics: Is the Central African Republic the World’s Worst Humanitarian Crisis?

Abstract

Abstract Background CAR is one of the poorest countries in the world. While UN statistics suggest that there is no health emergency in the country, two recently published mortality surveys contradict this. Moreover, recent accusations of massive scale human rights abuses by mercenaries suggested the need for a nationwide mortality survey. Methods Two stage cluster surveys were conducted in two different strata: one in the roughly half of the country within the Government’s control, and one in the prefectures mostly outside of the Government’s control. We randomly selected 40 clusters of 10 households in each strata. The survey included questions on vital events with open-ended questions about health and household challenges at the beginning and end of each interview. Results 70 of 80 selected clusters were successfully visited. We interviewed 699 households, containing 5070 people. 11 households (1.6%) refused to be interviewed and approximately 18.3% of households were absent at the time of visitation, mainly in the safer Government controlled areas. Interviewed households had a birth rate of 42.6 /1000 / year (95%CI 35.4–59.7) and a crude mortality rate (CMR) of 1.57 /10,000/day (95%CI: 1.36–1.78). The birth rate was lower and the death rate markedly higher in the strata outside of Government control. Families described malaria or fever, and diarrhea as the primary causes of death with violence only accounting for 6%. Conclusions CAR is experiencing a severe health emergency, with the highest measured nationwide mortality in the world to our knowledge. Official UN death rate estimates appear to be less than one fourth of reality. The population desperately needs access to food and basic health care and security restored. The UN should address the issue of mercenaries, operating outside the accountability of any Government, in contributing to humanitarian emergencies as is currently occurring in CAR.