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Open Access Research article

Health and human rights in eastern Myanmar prior to political transition: a population-based assessment using multistaged household cluster sampling

Parveen K Parmar13, Jade Benjamin-Chung2, Linda S Smith3, Saw Nay Htoo4, Sai Laeng5, Aye Lwin4, Mahn Mahn6, Cynthia Maung7, Daniel Reh8, Eh Kalu Shwe Oo9, Thomas Lee103 and Adam K Richards113*

Author Affiliations

1 Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA

2 Division of Epidemiology, UC Berkeley School of Public Health, 101 Haviland Hall, Berkeley, CA 94720-7358, USA

3 Community Partners International, 2560 Ninth St., Suite 315b, Berkeley, CA 94710, USA

4 Burma Medical Association, PO Box 156, Mae Sot, Tak, Thailand

5 Shan State Development Foundation, Chiang Mai, Thailand

6 Back Pack Health Worker Team, Mae Sot, Tak, Thailand

7 Mae Tao Clinic, Mae Sot, Tak, Thailand

8 Karenni Mobile Health Committee, Mae Hong Son, Thailand

9 Karen Department of Health and Welfare, PO box 189, Mae Sot, Tak 63110, Thailand

10 Adjunct Professor of Medicine, University of California, Los Angeles, CA, USA

11 Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA 90024, USA

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BMC International Health and Human Rights 2014, 14:15  doi:10.1186/1472-698X-14-15

Published: 5 May 2014



Myanmar/Burma has received increased development and humanitarian assistance since the election in November 2010. Monitoring the impact of foreign assistance and economic development on health and human rights requires knowledge of pre-election conditions.


From October 2008-January 2009, community-based organizations conducted household surveys using three-stage cluster sampling in Shan, Kayin, Bago, Kayah, Mon and Tanintharyi areas of Myanmar. Data was collected from 5,592 heads of household on household demographics, reproductive health, diarrhea, births, deaths, malaria, and acute malnutrition of children 6–59 months and women aged 15–49 years. A human rights focused survey module evaluated human rights violations (HRVs) experienced by household members during the previous year.


Estimated infant and under-five rates were 77 (95% CI 56 to 98) and 139 (95% CI 107 to 171) deaths per 1,000 live births; and the crude mortality rate was 13 (95% CI 11 to 15) deaths per thousand persons. The leading respondent-reported cause of death was malaria, followed by acute respiratory infection and diarrhea, causing 21.2% (95% CI 16.5 to 25.8), 16.6% (95% CI 11.8 to 21.4), and 12.3% (95% CI 8.7 to 15.8), respectively. Over a third of households suffered at least one human rights violation in the preceding year (36.2%; 30.7 to 41.7). Household exposure to forced labor increased risk of death among infants (rate ratio (RR) = 2.2; 95% CI 1.1 to 4.4) and children under five (RR = 2.1; 95% CI 1.3 to 3.6). The proportion of children suffering from moderate to severe acute malnutrition was higher among households that were displaced (prevalence ratio (PR) = 3.3; 95% CI 1.9 to 5.6).


Prior to the 2010 election, populations of eastern Myanmar experienced high rates of disease and death and high rates of HRVs. These population-based data provide a baseline that can be used to monitor national and international efforts to improve the health and human rights situation in the region.

Burma; Myanmar; Human Rights; Health; Mortality; Malaria