Mortality from anti-personnel mines before and during the Colombian peace process

  • Ramiro Manzano-Nunez a. School of Medicine and Health Sciences, Universidad del Rosario. Bogotá, Colombia. b. Méderi Hospital Universitario Mayor. Bogotá, Colombia. http://orcid.org/0000-0001-7444-9634
  • Maria P. Naranjo Clinical Research Center, Fundación Valle del Lili. Cali, Colombia.
  • Fredy Ariza Clinical Research Center, Fundación Valle del Lili. Cali, Colombia.
  • Javier E. Rengifo Clinical Research Center, Fundación Valle del Lili. Cali, Colombia.
  • Alexandra Gómez-Zuluaga Clinical Research Center, Fundación Valle del Lili. Cali, Colombia.
  • Daniela Vargas-Morales Clinical Research Center, Fundación Valle del Lili. Cali, Colombia.
  • Luis G. Parra-Lara Clinical Research Center, Fundación Valle del Lili. Cali, Colombia.
  • Julián Chica Clinical Research Center, Fundación Valle del Lili. Cali, Colombia.
  • Diana Martínez Clinical Research Center, Fundación Valle del Lili. Cali, Colombia.
  • Fernando Rosso Clinical Research Center, Fundación Valle del Lili. Cali, Colombia.
  • Juan C. Puyana University of Pittsburgh. Pittsburgh, PA, USA.
  • Alejandro Gaviria a. The Center for Sustainable Development in Latin America, Universidad de los Andes. Bogotá, Colombia. b. President, Universidad de los Andes. Bogotá, Colombia.
  • Alberto F. García Trauma and Acute Care Surgery Division, Department of Surgery, Fundación Valle del Lili. Cali, Colombia.
Keywords: Wounds and injuries, Amputation, Peace, Outcome assessment (health care), Colombia

Abstract

Introduction: Although the peace process in Colombia resulted in a significant reduction in the number of anti-personnel mines across the country, there are no reliable data on the effects of this phenomenon on outcomes for patients who were victims of these devices.

Objective: The objective of this study was to assess mortality from landmine injuries before and during the Colombian peace process. Furthermore possible associations between peace negotiations and mortality were explored.

Methods: For this study, we used the "Colombian Victims of Antipersonnel Mines Injuries registry" (MAP/MUSE database) data from 2002 to 2018. This registry was launched in 2001 by the government of Colombia with the aim of prospectively and systematically collect information on all the cases of anti-personnel mine injuries in the country. The period between 2002-2012 was classified as the pre-negotiation period (war period), and 2014-2018 as the peace negotiations period, with 2013 classified as a washout year. Multivariate logistic regression was used to explore the association between peace negotiations and mortality among anti-personnel landmine injured individuals.

Results: A total of 10306 landmine injury cases were registered. Of these, 1180 (11.4%) occurred in the peace-negotiation period. Mortality was significantly lower during the period of peace negotiations. After adjusting for sex, age group, race, active duty soldier status, rural area, and geographic departments case volumes, the peace negotiation period was found to be associated with lower risk-adjusted odds of mortality after suffering a landmine injury (OR= 0.6, 95% CI, 0.5-0.7; p<0.001).

Conclusion: Our findings suggest an association between the period of peace negotiation and a lower likelihood of mortality among victims of anti-personnel landmines.

References

Ordoñez CA, Manzano-Nunez R, Naranjo MP, Foianini E, Cevallos C, Londoño MA, et al. Casualties of peace: an analysis of casualties admitted to the intensive care unit during the negotiation of the comprehensive Colombian process of peace. World J Emerg Surg. 2018 Jan;13(1):2. doi: http://doi.org/10.1186/s13017-017-0161-2

Ordoñez CA, Manzano Nunez R, Parra MW, Herrera Escobar JP, Naranjo MP, Escobar SS, et al. Analysis of combat casualties admitted to the emergency department during the negotiation of the comprehensive Colombian process of peace. Colomb Med. 2018;48(4):155–60. doi: http://doi.org/10.25100/cm.v43i4.3389

Reardon S. Colombia: after the violence. NATURE. 2018. https://www.nature.com/immersive/d41586-018-04976-7/index.html Accessed 24 Jan 2019

Rubiano AM, Sánchez ÁI, Guyette F, Puyana JC. Trauma Care Training for National Police Nurses in Colombia. Prehosp Emerg Care. 2010;14(1):124–30. doi: http://doi.org/10.3109/10903120903349762

Edwards DS, Phillip RD, Bosanquet N, Bull AMJ, Clasper JC. What Is the Magnitude and Long-term Economic Cost of Care of the British Military Afghanistan Amputee Cohort? Clin Orthop Relat Res. 2015;473(9):2848–55. doi: http://doi.org/10.1007/s11999-015-4250-9

Duttine A, Hottentot E. Landmines and explosive remnants of war: a health threat not to be ignored. Bull World Health Organ. 2013 Mar 1;91(3):160-160A. doi: http://doi.org/10.2471/BLT.13.118885

Woodruff SI, Galarneau MR, Sack DI, McCabe CT, Dye JL. Combat amputeesʼ health-related quality of life and psychological outcomes. J Trauma Acute Care Surg. 2017 Mar;82(3):592–5. doi: http://doi.org/10.1097/TA.0000000000001348

Daniels JP. Frontline: caring for soldiers after the peace deal in Colombia. Lancet. 2017 Nov 22;390(10106):1939. doi: http://doi.org/10.1016/S0140-6736(17)32736-8

MAP/MUSE Database (Registro de información de afectación por MAP y MUSE e intervención). Colombian Government. 2018. http://www.accioncontraminas.gov.co/Estadisticas/datos-abiertos Accessed 25 Jan 2018

Guía rápida para saber cuándo someter su proyecto a evaluación del comité de ética en investigación de la Universidad del Rosario. Universidad del Rosario. 2018. https://www.urosario.edu.co/Documentos/Investigacion/Soporte-a-la-investigacion/Guia-para-saber-cuando-presentar-un-proyecto-a-eva.pdf Accessed 30 Jul 2020

Joshi M. Comprehensive peace agreement implementation and reduction in neonatal, infant and under-5 mortality rates in post-armed conflict states, 1989--2012. BMC Int Health Hum Rights. 2015;15(1):27. doi: 10.1186/s12914-015-0066-7

Gaffar AM, Mahfouz MS. Peace impact on health: population access to iodized salt in south Sudan in post-conflict period. Croat Med J. 2011 Apr 28;52(2):178–82. doi: http://doi.org/10.3325/cmj.2011.52.178

Desmettre T, Yeguiayan J-M, Coadou H, Jacquot C, Raux M, Vivien B, et al. Impact of emergency medical helicopter transport directly to a university hospital trauma center on mortality of severe blunt trauma patients until discharge. Crit Care. 2012 Sep 28;16(5):R170. doi: http://doi.org/10.1186/cc11647

Maddry JK, Perez CA, Mora AG, Lear JD, Savell SC, Bebarta VS. Impact of prehospital medical evacuation (MEDEVAC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations: a retrospective study. Mil Med Res. 2018;5(1):22. doi: http://doi.org/10.1186/s40779-018-0169-2

Holland SR, Apodaca A, Mabry RL. MEDEVAC: Survival and Physiological Parameters Improved With Higher Level of Flight Medic Training. Mil Med. 2013 May;178(5):529–36. doi: http://doi.org/10.7205/MILMED-D-12-00286

Gu W-J, Wu X-D, Zhou Q, Zhang J, Wang F, Ma Z-L, et al. Relationship between Annualized Case Volume and Mortality in SepsisA Dose–Response Meta-analysis. Anesthesiology. 2016 Jul 1;125(1):168–79. doi: http://doi.org/10.1097/ALN.0000000000001133

Hentschker C, Mennicken R. The Volume–Outcome Relationship Revisited: Practice Indeed Makes Perfect. Health Serv Res. 2017 Sep 4;53(1):15–34. doi: http://doi.org/10.1111/1475-6773.12696

Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon Volume and Operative Mortality in the United States. N Engl J Med. 2003 Nov 27;349(22):2117–27. doi: http://doi.org/10.1056/NEJMsa035205

Nathens A, Jurkovich G, Maier R, Grossman D, MacKenzie E, Moore M, et al. Relationship between trauma center volume and outcomes. JAMA. 2001 Mar 7;285(9):1164–71. doi: http://doi.org/10.1001/jama.285.9.1164

Westreich D, Greenland S. The Table 2 Fallacy: Presenting and Interpreting Confounder and Modifier Coefficients. Am J Epidemiol. 2013 Jan 30;177(4):292–8. doi: http://doi.org/10.1093/aje/kws412

Lamb CM, MacGoey P, Navarro AP, Brooks AJ. Damage control surgery in the era of damage control resuscitation. Br J Anaesth. 2014 Aug 1;113(2):242–9. doi: http://doi.org/10.1093/bja/aeu233

Cannon JW, Khan MA, Raja AS, Cohen MJ, Como JJ, Cotton BA, et al. Damage control resuscitation in patients with severe traumatic hemorrhage: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017 Mar;82(3):605–17. doi: http://doi.org/10.1097/TA.0000000000001333

Gani F, Cerullo M, Ejaz A, Gupta PB, Demario VM, Johnston FM, et al. Implementation of a Blood Management Program at a Tertiary Care Hospital: Effect on Transfusion Practices and Clinical Outcomes Among Patients Undergoing Surgery. Ann Surg. 2017 Nov 2;269(6):1073–1079. doi: http://doi.org/10.1097/SLA.0000000000002585.

How to Cite
1.
Manzano-Nunez R, Naranjo MP, Ariza F, Rengifo JE, Gómez-Zuluaga A, Vargas-Morales D, Parra-Lara LG, Chica J, Martínez D, Rosso F, Puyana JC, Gaviria A, García AF. Mortality from anti-personnel mines before and during the Colombian peace process. Colomb. J. Anesthesiol. [Internet]. 2020Dec.3 [cited 2021Jan.21];49. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/955

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Published
2020-12-03
How to Cite
1.
Manzano-Nunez R, Naranjo MP, Ariza F, Rengifo JE, Gómez-Zuluaga A, Vargas-Morales D, Parra-Lara LG, Chica J, Martínez D, Rosso F, Puyana JC, Gaviria A, García AF. Mortality from anti-personnel mines before and during the Colombian peace process. Colomb. J. Anesthesiol. [Internet]. 2020Dec.3 [cited 2021Jan.21];49. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/955
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