Increased mortality among Dutch development workers

Early this century Africa was known as the “white man's grave.” Little is known about health risks of expatriates in developing countries today. We compared the mortality of development workers who were sent out by Dutch development organisations with that of the general population in the Netherlands, adjusted for age and sex. Records of three large Dutch development organisations were reviewed. From 1984 to 1994 over 6500 development workers and spouses spent a total of 15144 years abroad. About 75% of them lived in sub-Saharan Africa. Causes of death were classified according to the International Classification of Diseases: mortality caused by traffic accidents (ICD 800-848), other injuries (ICD 880-959 and 980-989), homicide (ICD 960-969), and all other causes (ICD 001-799, 849-879, and 930-959).1 Age and sex specific mortality rates in the Dutch population were used to calculate the “expected” number of deaths in the study …