Interpreting results of cluster surveys in emergency settings: is the LQAS test the best option?

Cluster surveys are commonly used in humanitarian emergencies to measure health and nutrition indicators. Deitchler et al. have proposed to use Lot Quality Assurance Sampling (LQAS) hypothesis testing in cluster surveys to classify the prevalence of global acute malnutrition as exceeding or not exceeding the pre-established thresholds. Field practitioners and decision-makers must clearly understand the meaning and implications of using this test in interpreting survey results to make programmatic decisions. We demonstrate that the LQAS test–as proposed by Deitchler et al. – is prone to producing false-positive results and thus is likely to suggest interventions in situations where interventions may not be needed. As an alternative, to provide more useful information for decision-making, we suggest reporting the probability of an indicator's exceeding the threshold as a direct measure of "risk". Such probability can be easily determined in field settings by using a simple spreadsheet calculator. The "risk" of exceeding the threshold can then be considered in the context of other aggravating and protective factors to make informed programmatic decisions

Comparison of anthropometric data quality in children aged 6-23 and 24-59 months: lessons from population-representative surveys from humanitarian settings

BACKGROUND: Ensuring the quality of anthropometry data is paramount for getting accurate estimates of malnutrition prevalence among children aged 6-59 months in humanitarian and refugee settings. Previous reports based on data from Demographic and Health Surveys suggested systematic differences in anthropometric data quality between the younger and older groups of preschool children. METHODS: We analyzed 712 anthropometric population-representative field surveys from humanitarian and refugee settings conducted during 2011-2018. We examined and compared the quality of five anthropometric indicators in children aged 6-23 months and children aged 24-59 months: weight for height, weight for age, height for age, body mass index for age and mid-upper arm circumference (MUAC) for age. Using the z-score distribution of each indicator, we calculated the following parameters: standard deviation (SD), percentage of outliers, and measures of distribution normality. We also examined and compared the quality of height, weight, MUAC and age measurements using missing data and rounding criteria. RESULTS: Both SD and percentage of flags were significantly smaller on average in older than in younger age group for all five anthropometric indicators. Differences in SD between age groups did not change meaningfully depending on overall survey quality or on the quality of age ascertainment. Over 50% of surveys overall did not deviate significantly from normality. The percentage of non-normal surveys was higher in older than in the younger age groups. Digit preference score for weight, height and MUAC was slightly higher in younger age group, and for age slightly higher in the older age group. Children with reported exact date of birth (DOB) had much lower digit preference for age than those without exact DOB. SD, percentage flags and digit preference scores were positively correlated between the two age groups at the survey level, such as those surveys showing higher anthropometry data quality in younger age group also tended to show higher quality in older age group. CONCLUSIONS: There should be an emphasis on increased rigor of training survey measurers in taking anthropometric measurements in the youngest children. Standardization test, a mandatory component of the pre-survey measurer training and evaluation, of 10 children should include at least 4-5 children below 2 years of age

Famine Review of The IPC Acute Food Insecurity and Acute Malnutrition Analyses. Conclusions and Recommendations for Five Areas in Yemen (Abs, Haradh and Midi In Hajjah Governorate and Al Hali and Al Hawak in Al Hudaydah Governorate)

The Famine Review Committee (FRC) was activated with a request to assess the plausibility of the IPC Yemen Technical Working Group (TWG) Acute Food Insecurity (AFI) and Acute Malnutrition (AMN) classifications in five areas (Abs, Haradh and Midi in Hajjah Governorate and Al Hali and Al Hawak in Al Hudaydah governorate). The FRC found that the classifications and population estimates, conducted with the information available at the time of the analysis, are broadly plausible for the current and projected classifications in Abs, Al Hali and Al Hawak. However, the FRC concluded that there is not a body of evidence supporting a famine classification. for Midi and Haradh. The FRC considers the extrapolation done from Abs data, for both AFI and AMN analyses, are not plausible; and recommends the IPC TWG does not classify these areas but reassess the presence of populations residing in these districts as well as their conditions. It is paramount to note that in the immediate aftermath of the FRC activation, the Ukraine crisis unfolded generating the need to review the scenario definition for the projected period. The risks associated with the crisis in Ukraine point to the need to re-assess the assumptions developed by the IPC analysis teams. Notably the prices and supply of wheat and fuel, as well as a change in the geopolitics surrounding the Yemen conflict and possible shifts in humanitarian programming in the coming months. The FRC has identified a number of risk factors that may be subject to rapid change during 2022. These factors and/or the potential degree of change relate to recent developments and could not have been foreseen at the time of the Yemen IPC analyses. Nevertheless, the FRC believes these factors may affect the TWG classifications over the time periods they cover. The FRC urges the closest possible monitoring not only of each of the risk factors individually, particularly their cumulative impact, during the current and projection periods. Without close monitoring and rapid response to any changes, it is feasible that the severity of the food security, nutrition, and health situation in Yemen could exceed the levels currently specified in the current and projection time periods

A Decade Later, How Much of Rwanda's Musculoskeletal Impairment Is Caused by the War in 1994 and by Related Violence?

BACKGROUND: In 1994 there was a horrific genocide in Rwanda following years of tension, resulting in the murder of at least 800,000 people. Although many people were injured in addition to those killed, no attempt has been made to assess the lasting burden of physical injuries related to these events. The aim of this study was to estimate the current burden of musculoskeletal impairment (MSI) attributable to the 1994 war and related violence. METHODOLOGY/PRINCIPAL FINDINGS: A national cross-sectional survey of MSI was conducted in Rwanda. 105 clusters of 80 people were selected through probability proportionate to size sampling. Households within clusters were selected through compact segment sampling. Enumerated people answered a seven-question screening test to assess whether they might have an MSI. Those who were classed as potential cases in the screening test were examined and interviewed by a physiotherapist, using a standard protocol that recorded the site, nature, cause, and severity of the MSI. People with MSI due to trauma were asked whether this trauma occurred during the 1990-1994 war or during the episodes that preceded or followed this war. Out of 8,368 people enumerated, 6,757 were available for screening and examination (80.8%). 352 people were diagnosed with an MSI (prevalence=5.2%, 95% CI=4.5-5.9%). 106 cases of MSI (30.6%) were classified as resulting from trauma, based on self-report and the physiotherapist's assessment. Of these, 14 people (13.2%) reported that their trauma-related MSI occurred during the 1990-1994 war, and a further 7 (6.6%) that their trauma-related MSI occurred during the violent episodes that preceded and followed the war, giving an overall prevalence of trauma-related MSI related to the 1990-1994 war of 0.3% (95% CI=0.2-0.4%). CONCLUSIONS/SIGNIFICANCE: A decade on, the overall prevalence of MSI was relatively high in Rwanda but few cases appeared to be the result of the 1994 war or related violence

Cluster of Serogroup W135 Meningococci, Southeastern Florida, 2008–2009

Recently, 14 persons in southeastern Florida were identified with Neisseria meningitidis serogroup W135 invasive infections. All isolates tested had matching or near-matching pulsed-field gel electrophoresis patterns and belonged to the multilocus sequence type 11 clonal complex. The epidemiologic investigation suggested recent endemic transmission of this clonal complex in southeastern Florida

РОЛЬ ЕНДОТЕЛІАЛЬНОЇ ДИСФУНКЦІЇ В РОЗВИТКУ АРТЕРІАЛЬНОЇ ГІПЕРТЕНЗІЇ У ХВОРИХ НА АНКІЛОЗИВНИЙ СПОНДИЛОАРТРИТ

Purpose: to establish the role of endothelial dysfunction in the development of arterial hypertension in patients with ankylosing spondylarthritis.Materials and Methods. A total of 110 patients with AS were examined with evaluation endothelium-dependent vasodilation (EDVD). All patients received antihypertensive therapy which did not change throughout all study.Results. It was found that every third patient  suffered from hypertension, endothelial function disorders were detected in 71.8 % of patients. A large cohort of patients showed low levels of HDL and elevated levels of LDL.At the same time, significant differences in disease activity and functional status were found in the group with hypertension.Conclusions. We must assume that endothelial dysfunction, which occurs on the background of systemic inflammatory syndrome, is probably the main reason for the development of hypertension in patients with AS.Мета: встановити роль ендотеліальної дисфункції в розвитку артеріальної гіпертензії у хворих на анкілозивний спондилоартрит.Матеріали і методи. Обстежено 110 пацієнтів з анкілозивним спондилоартритом, яким проводили оцінку стану ендотелію. До моменту включення в дослідження всі пацієнти отримували базисну антигіпертензивну терапію, котра не змінювалась під час обстеження.Результати. Встановлено, що практично кожен третій пацієнт хворів на артеріальну гіпертензію, порушення функції ендотелію виявлено у 71,8 % хворих. Достатньо велика когорта обстежених демонструвала знижений рівень ЛПВЩ і підвищений рівень ЛПНЩ. Поряд із тим, виявлено суттєві відмінності за показниками активності за­хворювання (СРБ, ШОЕ, BASDAI) та функціонального статусу (BASFI) у пацієнтів з артеріальною гіпертензією та без.Висновки. Можна припустити, що саме дисфункція ендотелію, котра виникає на фоні системного запального синдрому, ймовірно, є основною причиною розвитку артеріальної гіпертензії у пацієнтів з анкілозивним спондилоартритом, адже відмінностей за іншими класичними факторами ССР, окрім дисліпідемій, виявлено не було

Performance of Small Cluster Surveys and the Clustered LQAS Design to estimate Local-level Vaccination Coverage in Mali

<p>Abstract</p> <p>Background</p> <p>Estimation of vaccination coverage at the local level is essential to identify communities that may require additional support. Cluster surveys can be used in resource-poor settings, when population figures are inaccurate. To be feasible, cluster samples need to be small, without losing robustness of results. The clustered LQAS (CLQAS) approach has been proposed as an alternative, as smaller sample sizes are required.</p> <p>Methods</p> <p>We explored (i) the efficiency of cluster surveys of decreasing sample size through bootstrapping analysis and (ii) the performance of CLQAS under three alternative sampling plans to classify local VC, using data from a survey carried out in Mali after mass vaccination against meningococcal meningitis group A.</p> <p>Results</p> <p>VC estimates provided by a 10 × 15 cluster survey design were reasonably robust. We used them to classify health areas in three categories and guide mop-up activities: i) health areas not requiring supplemental activities; ii) health areas requiring additional vaccination; iii) health areas requiring further evaluation. As sample size decreased (from 10 × 15 to 10 × 3), standard error of VC and ICC estimates were increasingly unstable. Results of CLQAS simulations were not accurate for most health areas, with an overall risk of misclassification greater than 0.25 in one health area out of three. It was greater than 0.50 in one health area out of two under two of the three sampling plans.</p> <p>Conclusions</p> <p>Small sample cluster surveys (10 × 15) are acceptably robust for classification of VC at local level. We do not recommend the CLQAS method as currently formulated for evaluating vaccination programmes.</p

Landmine injuries at the Emergency Management Center in Erbil, Iraq

<p>Abstract</p> <p>Background</p> <p>Landmines can cause death, injury and disability in addition to many indirect public health consequences. This study aimed at understanding the trends, demography and other epidemiological characteristics of hospitalized landmine injured patients in Erbil governorate.</p> <p>Methods</p> <p>The case records of landmine injured patients who had been admitted to the Emergency Management Centre in Erbil city from July 1998 to July 2007 were reviewed and descriptively analyzed.</p> <p>Results</p> <p>Two hundred eighty five landmine injured patients were admitted to the center, their mean ± SD age was 26.5 ± 13.2 years (range 6-71 years), 95.1% were males, nearly 50% were between 19 to 35 years of age and 96.8% were civilians. Around 72% of victims sustained limb amputations; 58.6% lower limb and 13.3% upper limb out of the total. The hospital mortality rate was 2.1%. The number of admissions for landmine injury was steadily decreasing between July 1998 and July 2001, followed by prominent increase between July 2002 and July 2003. The highest proportion of admissions occurred in summer (35.4%) and majority of incidents occurred along the borders with Iran and Turkey (61.8%).</p> <p>Conclusion</p> <p>Civilian male adolescents and young adults constituted the majority of hospitalized landmine victims in Erbil governorate. While a high proportion of victims sustained lower limb amputations, upper limb amputations particularly among children and injury to head and face were relatively common which might be attributed to handling explosives. This emphasizes the need to examine the reasons behind handling explosives.</p