Population trends related to injury from explosive munitions in Lao PDR (1964–2008): a retrospective analysis

Stacey E. Pizzino, Samuel Hundessa, Vinu Verghis, Mark Griffin, Jo Durham

The presence of landmines and explosive remnants of war (ERW) including unexploded ordnance (UXO) poses a serious public health risk for populations living in conflict-affected and contaminated areas. Current analysis, however, provides only a partial view of the burden. In this study, we examined the multivariable relationship between year of injury, activity at the time of the incident, case fatalities and casualty rates in order to provide decision-makers with a more fine-grained understanding of landmines and ERW injuries in the Lao PDR. Using data from a retrospective, national household survey, frequency tables, logistic and Poisson regressions were performed using STATA 13 to predict the case fatality and population-standardized incidence rates for ERW casualties. The findings indicated that most casualties were male (86.75%), with the majority of incidents (74.7%) occurring during the conflict period (1964-1979). The odds of death for the conflict period was 1.5 times that of the post-conflict period (1980-2008). The highest odds of death during the conflict period was associated with big bombs (OR = 1.38, 95% CI: 1.243-1.522, p < 0.01), and landmine injuries were more common during conflict compared to the post-conflict period (IRR = 1.42, 95% CI: 1.368-1.477, p < 0.01). Post conflict, cluster munitions had the highest incidence rate for death or injury (IRR = 1.07, 95%CI: 1.006-1.143, p = 0.03). Scrap collection which is often the target of mine risk education and thought to be one of the main activities at time of injury had the second lowest incidence rate of the activities related to incident during post-conflict period. As the first study of this nature in Lao PDR, this research provides information essential for planning services and prevention. This study suggests more effort needs to be directed towards addressing the geographical regions and population subgroups experiencing increased casualty numbers and odds of death. Further research is required to improve the documentation and understanding of the health and socio-economic consequences of landmine and ERW injuries.