Users' guides to the medical literature: how to use an article about mortality in a humanitarian emergency

You are a physician working for an international humanitarian medical organization as head of mission. You have recently arrived in the North Kivu province in the Eastern Democratic Republic of Congo (DRC) and are conducting a health assessment of the region to inform your medical response intervention. Media reports suggest that mortality from violence are extremely high in this area of the country, but a more accurate assessment of mortality – both directly and indirectly related to violence – will assist you in setting priorities and may mandate a call for additional medical specialists.Political agendas may distort media reports of violence and death and the quality of the evidence on which the reports rely may be low. Further, media reports are likely to omit deaths from malnutrition and infection, often the most common causes of mortality in protracted violent settings [1,2]. The need for higher quality evidence prompts you to formulate a question of public health relevance: "In the protracted conflict setting of the Democratic Republic of Congo, to what extent is mortality elevated in conflict zones compared to other countries in the region, and what is the nature of any increase in mortality?"When searching for recent reports about mortality in the DRC both large studies broadly representing the national population and studies of the North Kivu community in which the NGO intends to implement programmes would be useful. You will follow the recommendations of the Standardized Monitoring and Assessment of Relief and Transition (SMART) initiative and seek studies of high quality [3]. You will ask a support team in the capital, Kinshasa – your own electronic access is painfully slow – to seek retrospective surveys with coverage that represent the population and the time period of interest.Because many NGO reports will be unpublished [4], your team will contact local offices of UN agencies, as well as major data collecting NGOs such as Médecins Sans Frontières, Ac