Setting and Sample Selection We employed a two-stage cluster sampling method. An ethicist experienced in international research associated with the Institute of Translational Health Sciences at the University of Washington, Benjamin Wilfond, further reviewed the protocols to ensure the safety of participants and interviewers was adequately protected. We used the ICSS method to adjust for these biases . By doubling the number of clusters used in two previous mortality studies  ,  , we were able to reduce the possibility of missing pockets of unusually high or low conflict-related mortality, and by halving the number of households per cluster we were able to keep the operational complexity of conducting the survey manageable, and still visit a reasonable number of households per cluster. To estimate upper and lower uncertainty bounds, we used the bootstrapping method described above. We trained interviewers to probe for sensitive information about missing or disappeared persons, and about events distant in time among siblings and household members. Instruments Each paper questionnaire contained a household and a sibling component. Ethical Review We had review board approval from each participating institution in the study. We were obliged, however, to drop two remote clusters where our teams were strongly advised by community leaders not to visit dwellings for cultural reasons ; instead, household members were invited to a central location for interviews.
The questionnaire is provided as Questionnaire S1. There is evidence that the killings in Iraq were disproportionately targeted towards the higher-income intelligentsia, a group typically in a better position to migrate to a safer setting if under attack . No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We were obliged, however, to drop two remote clusters where our teams were strongly advised by community leaders not to visit dwellings for cultural reasons ; instead, household members were invited to a central location for interviews. In the first stage of cluster selection, we randomly selected 1-km2 areas using a probability-proportional-to-size approach. Data were recorded on paper forms, and then entered using EpiData soon after collection see full dataset at http: We trained interviewers to probe for sensitive information about missing or disappeared persons, and about events distant in time among siblings and household members. We compiled qualitative observations about the remoteness and other characteristics of each cluster. We then divided this total by an estimated household size, and multiplied total households by the average fraction of deaths per household  to estimate the total deaths our household survey would have missed, and added this number to our total death count. If two or more siblings lived together in the same home, we interviewed only one whichever one was actually present, or, if all were present, the sibling with the nearest next birthday to the date of our visit. These representative households are then queried about their composition and mortality events over a given time period, to allow researchers to generate crude death rates; these rates are then multiplied by the country's population total to calculate a death estimate . None of these were conducted after , the peak of the conflict and subsequent migration . We used the ICSS method to adjust for these biases . Weekly or more frequent teleconferences were held between the North American team and the lead Iraqi investigator during the design and implementation phases. For each of these 1, replicates, we calculated annual crude death rates. Interviewers asked for causes of death, and coded these from a brief listing of common causes. We allowed limited proxy reporting for siblings. For war-related deaths, we asked for specific causes such as gunshots or explosions and perceived responsible parties such as coalition forces or criminals. To account for clustering, we first sampled with replacement the 98 existing clusters 1, times, so that each time we selected 98 clusters—with some of the original clusters sampled more than once, and some not sampled at all. An ethicist experienced in international research associated with the Institute of Translational Health Sciences at the University of Washington, Benjamin Wilfond, further reviewed the protocols to ensure the safety of participants and interviewers was adequately protected. After removing the two clusters previously mentioned, the total household count was 1,, with an average of 5. Our field manual see Manual S1 established protocols for selecting 19 dwellings adjacent to the starting household. Next, for each of the 1, sets of clusters, we resampled the original number of households with replacement within each of the 98 sampled clusters. We used a commercial software product LandScan that contained gridded population data at the 1-km2 level in a geographic information system, and we linked it to Google Earth imagery. To create a war-related death count for the total population, we used the yearly United Nations Population Division estimates  for Iraq multiplied by the war-related crude death rate. Sibships that experience a higher mortality risk are underrepresented at the time of the survey, because these siblings are less likely to survive to be able to report survival bias.
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